1
|
Gao J, Shi J, Ma X, Lu F, Fu C, Chen Z, Miao L, Qu H, Zhao Y, Zhang Y, Yang Z, Pan D, Zhu C, Li Q, Shi D. Effects of ginseng berry saponins from panax ginseng on glucose metabolism of patients with prediabetes: A randomized, double-blinded, placebo-controlled, crossover trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 132:155842. [PMID: 39004031 DOI: 10.1016/j.phymed.2024.155842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/31/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Prediabetes strongly increases the risk of type 2 diabetes and cardiovascular events. However, lifestyle intervention, the first-line treatment for prediabetes currently, was inconsistently beneficial for glucose metabolism, and the conventional medicines, such as metformin, is controversial for prediabetes due to the possible side effects. PURPOSE This study was designed to evaluate the effects of Zhenyuan Capsule, a Chinese patented medicine consisting of ginseng berry saponins extracted from the mature berry of Panax Ginseng, on the glucose metabolism of prediabetic patients as a complementary therapy. STUDY DESIGN AND METHODS In this randomized, double-Blinded, placebo-controlled, crossover trial, 195 participants with prediabetes were randomized 1:1 to receive either placebo followed by Zhenyuan Capsule, or vice versa, alongside lifestyle interventions. Each treatment period lasted 4 weeks with a 4-week washout period in between. The primary outcomes were the changes in fasting plasma glucose (FPG) and 2-h postprandial plasma glucose (2-h PG) from baseline. Secondary outcomes includes the changes in fasting and 2-h postprandial insulin and C-peptide, the homeostatic model assessment-insulin resistance (HOMA-IR) index and quantitative insulin sensitivity check index (QUICKI) from baseline. Blood lipids and adverse events were also assessed. RESULTS Compared with placebo, Zhenyuan Capsule caused remarkable reduction in 2-h PG (-0.98 mmol/l) after adjusting treatment order. Zhenyuan Capsule also reduced the fasting and 2-h postprandial levels of insulin and C-peptide, lowered HOMA-IR index (-1.26), and raised QUICKI index (+0.012) when compared to placebo. Additionally, a significant increase in high density lipoprotein cholesterol (HDL-C; +0.25 mmol/l) was found in patients with Zhenyuan Capsule. No serious adverse event occurred during the study. CONCLUSIONS Among prediabetic patients, Zhenyuan Capsule further reduced 2-h PG level, alleviated insulin resistance and raised HDL-C level on the background of lifestyle interventions. The study protocol is registered with the Chinese Clinical Trial Registry (ChiCTR2000034000).
Collapse
Affiliation(s)
- Jie Gao
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China academy of Chinese Medical Sciences, Beijing,100091, China
| | - Junhe Shi
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xiaojuan Ma
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China academy of Chinese Medical Sciences, Beijing,100091, China
| | - Fang Lu
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Changgeng Fu
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Zhuhong Chen
- Department of endocrinology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Lina Miao
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China academy of Chinese Medical Sciences, Beijing,100091, China
| | - Hua Qu
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yang Zhao
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Ying Zhang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China academy of Chinese Medical Sciences, Beijing,100091, China
| | - Zhen Yang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China academy of Chinese Medical Sciences, Beijing,100091, China
| | - Deng Pan
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China academy of Chinese Medical Sciences, Beijing,100091, China
| | - Chunlin Zhu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China academy of Chinese Medical Sciences, Beijing,100091, China
| | - Qiuyan Li
- Department of endocrinology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
| | - Dazhuo Shi
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China academy of Chinese Medical Sciences, Beijing,100091, China.
| |
Collapse
|
2
|
Madenci AL, Kurgansky KE, Dickerman BA, Gerlovin H, Wanis KN, Smith AD, Trinquart L, Gagnon DR, Cho K, Gaziano JM, Casas JP, Robins JM, Hernán MA. Estimating the Effect of Bariatric Surgery on Cardiovascular Events Using Observational Data? Epidemiology 2024; 35:721-729. [PMID: 39024034 DOI: 10.1097/ede.0000000000001765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Observational studies have reported strongly protective effects of bariatric surgery on cardiovascular disease, but with oversimplified definitions of the intervention, eligibility criteria, and follow-up, which deviate from those in a randomized trial. We describe an attempt to estimate the effect of bariatric surgery on cardiovascular disease without introducing these sources of bias, which may not be entirely possible with existing observational data. METHODS We propose two target trials among persons with diabetes: (1) bariatric operation (vs. no operation) among individuals who have undergone preoperative preparation (lifestyle modifications and screening) and (2) preoperative preparation and a bariatric operation (vs. neither preoperative nor operative component). We emulated both target trials using observational data of US veterans. RESULTS Comparing bariatric surgery with no surgery (target trial #1; 8,087 individuals), the 7-year cardiovascular risk was 18.0% (95% CI = 6.9, 32.7) in the surgery group and 18.9% (95% CI = 17.7, 20.1) in the no-surgery group (risk difference -0.9, 95% CI = -12.0, 14.0). Comparing preoperative components plus surgery vs. neither (target trial #2; 10,065 individuals), the 7-year cardiovascular risk was 17.4% (95% CI = 13.6, 22.0) in the surgery group and 18.8% (95% CI = 17.8, 19.9) in the no-surgery group (risk difference -1.4, 95% CI = -5.1, 3.2). Body mass index and hemoglobin A1c were reduced with bariatric interventions in both emulations. CONCLUSIONS Within limitations of available observational data, our estimates do not provide evidence that bariatric surgery reduces cardiovascular disease and support equipoise for a randomized trial of bariatric surgery for cardiovascular disease prevention.
Collapse
Affiliation(s)
- Arin L Madenci
- From the CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | - Barbra A Dickerman
- From the CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Kerollos Nashat Wanis
- From the CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Surgery, Western University, London, ON
| | - Ann D Smith
- Veterans Affairs Boston Healthcare System, Boston, MA
| | - Ludovic Trinquart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - David R Gagnon
- Veterans Affairs Boston Healthcare System, Boston, MA
- Boston University School of Public Health, Boston, MA
| | - Kelly Cho
- Veterans Affairs Boston Healthcare System, Boston, MA
| | - J Michael Gaziano
- Veterans Affairs Boston Healthcare System, Boston, MA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Juan P Casas
- Veterans Affairs Boston Healthcare System, Boston, MA
| | - James M Robins
- From the CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Miguel A Hernán
- From the CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
3
|
Saad A, Cherian L, Benameur K. Lifestyle Factors and Stroke Prevention: From the Individual to the Community. Curr Neurol Neurosci Rep 2024:10.1007/s11910-024-01370-x. [PMID: 39180656 DOI: 10.1007/s11910-024-01370-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE OF REVIEW The overwhelming majority of stroke burden can be prevented through the pillars of lifestyle medicine: diet, exercise, sleep, substance abuse, stress management, and healthy relationships. Among these, diet confers the greatest attributable risk. RECENT FINDINGS Despite abundant data and integration of lifestyle medicine within major stroke prevention guidelines, several barriers to effective implementation remain. These include lack of emphasis in medical education, integration in hospital certification metrics, reimbursement from medical insurance, and health policy that inadequately addresses social determinants of health. However, both top-down and bottom-up solutions introduced within the last few years are helping to break down these barriers. This review highlights recent literature and interventions that are closing the gap between the theory and practice of stroke prevention through lifestyle risk factors from a US perspective. By strategically targeting the various institutional barriers, it is possible and essential to substantially reduce stroke burden.
Collapse
Affiliation(s)
- Ali Saad
- Climate & Health Program, University of Colorado, 13001 East 17th Place Campus Box C290, Aurora, 80045, CO, United States.
| | - Laurel Cherian
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, U.S.A
| | - Karima Benameur
- Department of Neurology, Emory University, Atlanta, GA, U.S.A
| |
Collapse
|
4
|
Green JB, Crowley MJ, Thirunavukkarasu S, Maruthur NM, Oldenburg B. The Final Frontier in Diabetes Care: Implementing Research in Real-World Practice. Diabetes Care 2024; 47:1299-1310. [PMID: 38907682 DOI: 10.2337/dci24-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/25/2024] [Indexed: 06/24/2024]
Abstract
Despite extensive evidence related to the prevention and management of type 2 diabetes (T2D) and its complications, most people at risk for and people who have diabetes do not receive recommended guideline-based care. Clinical implementation of proven care strategies is of the utmost importance because without this, even the most impressive research findings will remain of purely academic interest. In this review, we discuss the promise and challenges of implementing effective approaches to diabetes prevention and care in the real-world setting. We describe successful implementation projects in three critical areas of diabetes care-diabetes prevention, glycemic control, and prevention of diabetes-related complications-which provide a basis for further clinical translation and an impetus to improve the prevention and control of T2D in the community. Advancing the clinical translation of evidence-based care must include recognition of and assessment of existing gaps in care, identification of barriers to the delivery of optimal care, and a locally appropriate plan to address and overcome these barriers. Care models that promote team-based approaches, rather than reliance on patient-provider interactions, will enhance the delivery of contemporary comprehensive diabetes care.
Collapse
Affiliation(s)
- Jennifer B Green
- Division of Endocrinology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Matthew J Crowley
- Division of Endocrinology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Sathish Thirunavukkarasu
- Department of Family and Preventive Medicine, Emory School of Medicine, Atlanta, GA
- Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Nisa M Maruthur
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian Oldenburg
- Department of Public Health and Implementation Science, La Trobe University, and Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Li B, Liu Y, Zhou X, Chen L, Yan L, Tang X, Gao Z, Wan Q, Luo Z, Qin G, Ning G, Gu W, Mu Y. Remnant cholesterol is more positively related to diabetes, prediabetes, and insulin resistance than conventional lipid parameters and lipid ratios: A multicenter, large sample survey. J Diabetes 2024; 16:e13592. [PMID: 39136535 PMCID: PMC11320755 DOI: 10.1111/1753-0407.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/30/2024] [Accepted: 05/17/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Not many large-sample investigations are available that compare the potency of the relationship of remnant cholesterol (RC) and other lipid parameters with diabetes and prediabetes. The goals of our study are to discover the relationship between RC and prediabetes, diabetes, and insulin resistance (IR) and to investigate RC, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C, which are the lipid parameters that are most positively related to diabetes, prediabetes, and IR. METHODS This research enrolled 36 684 subjects from China's eight provinces. We employed multiple logistic regression analysis for testing the relationship between lipid parameters and diabetes, prediabetes, and IR. RESULTS After adjusting for potential confounders, and comparing the results with other lipid parameters, the positive relationship between RC and diabetes (odds ratio [OR] 1.417, 95% confidence interval [CI]: 1.345-1.492), prediabetes (OR 1.555, 95% CI: 1.438-1.628), and IR (OR 1.488, 95% CI: 1.404-1.577) was highest. RC was still related to diabetes, prediabetes, and IR even when TG <2.3 mmol/L (diabetes: OR 1.256, 95% CI: 1.135-1.390; prediabetes: OR 1.503, 95% CI: 1.342-1.684; and IR: OR 1.278, 95% CI: 1.140-1.433), LDL-C <2.6 mmol/L (diabetes: OR 1.306, 95% CI: 1.203-1.418; prediabetes: OR 1.597, 95% CI: 1.418-1.798; and IR: OR 1.552, 95% CI: 1.416-1.701), or HDL-C ≥1 mmol/L (diabetes: OR 1.456, 95% CI: 1.366-1.550; prediabetes: OR 1.553, 95% CI: 1.421-1.697; and IR: OR 1.490, 95% CI: 1.389-1.598). CONCLUSION RC is more positively related to diabetes, prediabetes, and IR than conventional lipids and lipid ratios in the general population, the relationships between RC and diabetes, prediabetes, and IR are stable, even if HDL-C, LDL-C, or TG are at appropriate levels.
Collapse
Affiliation(s)
- Binqi Li
- School of MedicineNankai UniversityTianjinChina
- Department of EndocrinologyFirst Medical Center of PLA General HospitalBeijingChina
| | - Yang Liu
- Department of EndocrinologyFirst Medical Center of PLA General HospitalBeijingChina
- Department of EndocrinologyEighth Medical Center of PLA General HospitalBeijingChina
| | - Xin Zhou
- Graduate SchoolChinese PLA General HospitalBeijingChina
- Department of Medical OncologyFifth Medical Center of Chinese PLA General HospitalBeijingChina
- The Second Medical Center of Chinese PLA General HospitalBeijingChina
| | - Lulu Chen
- Wuhan Union HospitalHuazhong University of Science and TechnologyWuhanChina
| | - Li Yan
- Department of EndocrinologyZhongshan University Sun Yat‐sen Memorial HospitalGuangzhouChina
| | - Xulei Tang
- Department of EndocrinologyFirst Hospital of Lanzhou UniversityLanzhouChina
| | - Zhengnan Gao
- Department of EndocrinologyDalian Central HospitalDalianChina
| | - Qin Wan
- Department of EndocrinologySouthwest Medical University Affiliated HospitalLuzhouChina
| | - Zuojie Luo
- Department of endocrinologyFirst Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Guijun Qin
- Department of endocrinologyFirst Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Guang Ning
- Department of Endocrinology, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Weijun Gu
- Department of EndocrinologyFirst Medical Center of PLA General HospitalBeijingChina
- Department of EndocrinologyEighth Medical Center of PLA General HospitalBeijingChina
- Graduate SchoolChinese PLA General HospitalBeijingChina
| | - Yiming Mu
- School of MedicineNankai UniversityTianjinChina
- Department of EndocrinologyFirst Medical Center of PLA General HospitalBeijingChina
- Department of EndocrinologyEighth Medical Center of PLA General HospitalBeijingChina
- Graduate SchoolChinese PLA General HospitalBeijingChina
| |
Collapse
|
6
|
Lingvay I, Deanfield J, Kahn SE, Weeke PE, Toplak H, Scirica BM, Rydén L, Rathor N, Plutzky J, Morales C, Lincoff AM, Lehrke M, Jeppesen OK, Gajos G, Colhoun HM, Cariou B, Ryan D. Semaglutide and Cardiovascular Outcomes by Baseline HbA1c and Change in HbA1c in People With Overweight or Obesity but Without Diabetes in SELECT. Diabetes Care 2024; 47:1360-1369. [PMID: 38907684 PMCID: PMC11282385 DOI: 10.2337/dc24-0764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/08/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To evaluate the cardiovascular effects of semaglutide by baseline glycated hemoglobin (HbA1c) and change in HbA1c in a prespecified analysis of Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity (SELECT). RESEARCH DESIGN AND METHODS In SELECT, people with overweight or obesity and atherosclerotic cardiovascular disease without diabetes were randomized to weekly semaglutide 2.4 mg or placebo. The primary end point of first major adverse cardiovascular event (MACE) (cardiovascular mortality, nonfatal myocardial infarction, or stroke) was reduced by 20% with semaglutide versus placebo. Analysis of outcomes included first MACE, its individual components, expanded MACE (cardiovascular mortality, nonfatal myocardial infarction, or stroke; coronary revascularization; or hospitalization for unstable angina), a heart failure composite (heart failure hospitalization or urgent medical visit or cardiovascular mortality), coronary revascularization, and all-cause mortality by baseline HbA1c subgroup and categories of HbA1c change (<-0.3, -0.3 to 0.3, and >0.3 percentage points) from baseline to 20 weeks using the intention-to-treat principle with Cox proportional hazards. RESULTS Among 17,604 participants (mean age 61.6 years, 72.3% male), baseline HbA1c was <5.7% for 33.5%, 5.7% to <6.0% for 34.6%, and 6.0% to <6.5% for 31.9%. Cardiovascular risk reduction with semaglutide versus placebo was not shown to be different across baseline HbA1c groups and was consistent with that of the overall study for all end points, except all-cause mortality. Cardiovascular outcomes were also consistent across subgroups of HbA1c change. CONCLUSIONS In people with overweight or obesity and established atherosclerotic cardiovascular disease but not diabetes, semaglutide reduced cardiovascular events irrespective of baseline HbA1c or change in HbA1c. Thus, semaglutide is expected to confer cardiovascular benefits in people with established atherosclerotic cardiovascular disease who are normoglycemic at baseline and/or in those without HbA1c improvements.
Collapse
Affiliation(s)
- Ildiko Lingvay
- Department of Internal Medicine/Endocrinology and Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | - John Deanfield
- Institute of Cardiovascular Science, University College London, London, U.K
| | - Steven E. Kahn
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
| | | | - Hermann Toplak
- Division of Endocrinology and Diabetology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Benjamin M. Scirica
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | | | - Jorge Plutzky
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - A. Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
| | | | | | - Grzegorz Gajos
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
| | - Helen M. Colhoun
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, U.K
| | - Bertrand Cariou
- L’institut du thorax, INSERM, CNRS, CHU Nantes, Nantes Université, Nantes, France
| | - Donna Ryan
- Pennington Biomedical Research Center, Baton Rouge, LA
| | | |
Collapse
|
7
|
Bailey CJ. Metformin: Therapeutic profile in the treatment of type 2 diabetes. Diabetes Obes Metab 2024; 26 Suppl 3:3-19. [PMID: 38784991 DOI: 10.1111/dom.15663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
Metformin (dimethyl-biguanide) can claim its origins in the use of Galega officinalis as a plant treatment for symptoms ascribed to diabetes. Since the first clinical use of metformin as a glucose-lowering agent in 1957, this medicine has emerged as a first-line pharmacological option to support lifestyle interventions in the management of type 2 diabetes (T2D). It acts through multiple cellular pathways, principally in the gut, liver and muscle, to counter insulin resistance and lower blood glucose without weight gain or risk of overt hypoglycaemia. Other effects include improvements in lipid metabolism, decreased inflammation and lower long-term cardiovascular risk. Metformin is conveniently combined with other diabetes medications, can be prescribed in prediabetes to reduce the risk of progression to T2D, and is used in some regions to assist glycaemic control in pregnancy. Consistent with its diversity of actions, established safety profile and cost-effectiveness, metformin is being assessed for further possible clinical applications. The use of metformin requires adequate renal function for drug elimination, and may cause initial gastrointestinal side effects, which can be moderated by taking with meals or using an extended-release formulation. Thus, metformin serves as a valuable therapeutic resource for use throughout the natural history of T2D.
Collapse
|
8
|
Han Q, Yu Y, Liu X, Guo Y, Shi J, Xue Y, Li Y. The Role of Endothelial Cell Mitophagy in Age-Related Cardiovascular Diseases. Aging Dis 2024:AD.2024.0788. [PMID: 39122456 DOI: 10.14336/ad.2024.0788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Aging is a major risk factor for cardiovascular diseases (CVD), and mitochondrial autophagy impairment is considered a significant physiological change associated with aging. Endothelial cells play a crucial role in maintaining vascular homeostasis and function, participating in various physiological processes such as regulating vascular tone, coagulation, angiogenesis, and inflammatory responses. As aging progresses, mitochondrial autophagy impairment in endothelial cells worsens, leading to the development of numerous cardiovascular diseases. Therefore, regulating mitochondrial autophagy in endothelial cells is vital for preventing and treating age-related cardiovascular diseases. However, there is currently a lack of systematic reviews in this area. To address this gap, we have written this review to provide new research and therapeutic strategies for managing aging and age-related cardiovascular diseases.
Collapse
Affiliation(s)
- Quancheng Han
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yiding Yu
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiujuan Liu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yonghong Guo
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jingle Shi
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yitao Xue
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yan Li
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|
9
|
Qian X, Wang J, Gong Q, An Y, Feng X, He S, Chen X, Wang W, Zhang L, Hui Y, Zhai X, Zhang B, Chen Y, Li G. Non-diabetes status after diagnosis of impaired glucose tolerance and risk of long-term death and vascular complications: A post hoc analysis of the Da Qing Diabetes Prevention Outcome Study. PLoS Med 2024; 21:e1004419. [PMID: 38980837 PMCID: PMC11233008 DOI: 10.1371/journal.pmed.1004419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/23/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The association between years of non-diabetes status after diagnosis of impaired glucose tolerance (IGT) and the risk of long-term death and cardiovascular outcomes needed to be clarified. METHODS AND FINDINGS In this post hoc analysis, we included 540 individuals with IGT who participated in the original Da Qing Diabetes Prevention Study (DQDPS). In the DQDPS, all participants were diagnosed with IGT by a 75 g oral glucose tolerance test and randomized to intervention or control groups with a 6-year lifestyle intervention trial. After the completion of the trial, death, cardiovascular events, and microvascular complications were monitored over a 30-year follow-up. In this post hoc analysis, the Cox analysis assessed the extended risk of these outcomes in individuals who either remained non-diabetes status or progressed to diabetes at the end of 2, 4, and 6 years after diagnosis of IGT. In all participants, the difference in the cumulative incidence rate of the outcomes between the diabetes and non-diabetes group gradually increased over 30 years. Compared with the diabetes group, a significantly lower risk of all-cause death (hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.57 to 0.97, p = 0.026), cardiovascular events (HR: 0.63; 95% CI: 0.49 to 0.82, p < 0.001), and microvascular complications (HR: 0.62; 95% CI: 0.45 to 0.86, p = 0.004) first emerged in individuals who remained non-diabetes at the 4 years visit, whereas the significant risk reduction in cardiovascular death was first observed at the end of 6 years (HR: 0.56; 95% CI: 0.39 to 0.81, p = 0.002) after adjustment for age, sex, smoking status, BMI, systolic blood pressure, blood glucose, total cholesterol, intervention, and medications (including insulin plus oral hypoglycaemics, antihypertensives, and lipid-lowering agents). The results in the original intervention group alone were similar to the whole group. The main limitations of our study are the limited number of participants and the sole ethnicity of the Chinese population. CONCLUSIONS In this study, we observed that maintaining several years of non-diabetes status after IGT diagnosis was associated with a significant reduction in long-term risk of death and vascular complications, and for most of these outcomes, maintaining at least 4 years of non-diabetes status may be needed to achieve a significant risk reduction.
Collapse
Affiliation(s)
- Xin Qian
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinping Wang
- Department of Cardiology, Da Qing First Hospital, Da Qing, China
| | - Qiuhong Gong
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yali An
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinxing Feng
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyao He
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoping Chen
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Wenjuan Wang
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lihong Zhang
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanchi Hui
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuwei Zhai
- Department of Neurosurgery, Da Qing First Hospital, Da Qing, China
| | - Bo Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Yanyan Chen
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangwei Li
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
10
|
Murai K, Fujihara K, Harada Yamada M, Matsubayashi Y, Yamada T, Iwanaga M, Kitazawa M, Yamamoto M, Osawa T, Yaguchi Y, Kodama S, Sone H. Impact of health practice index and cardiovascular health metrics on incident cardiovascular disease according to glucose tolerance status. Diabetol Int 2024; 15:456-464. [PMID: 39101183 PMCID: PMC11291790 DOI: 10.1007/s13340-024-00708-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/02/2024] [Indexed: 08/06/2024]
Abstract
Aims To evaluate and compare the association of incident cardiovascular disease (CVD) with the Health Practice Index (HPI) reflecting only lifestyle habits and Ideal Cardiovascular Health Metrics (ICVHMs) consisting of lifestyle habits and factors targeted for control in the same population according to glucose status. Methods This retrospective cohort study included 1,28,162 participants aged 18-72 years with no history of CVD followed for ≥ 3 years between 2008 and 2016. Participants were classified according to normal glucose tolerance (86,174), prediabetes (36,096), or diabetes (5892). HPI and ICVHMs scores were classified into three groups (high/medium/low). Multivariate Cox regression hazard analysis examined CVD risk. Results During a mean follow-up of 5.2 years, 1057 CVD events occurred. In prediabetes, CVD risk was significantly higher in groups with both medium and low HPI scores and ICVHMs scores compared to high scores for normal glucose tolerance (hazard ratios [HRs] for high/medium/low HPI scores were 0.95 [0.78-1.17], 1.56 [1.29-1.89], and 2.41 [1.74-3.34] and for ICVHMs scores were 0.74 [0.50-1.11], 1.58 [1.26-1.98], and 2.63 [2.10-3.31], respectively). Regarding diabetes, compared with high HPI/ICVHMs scores in the normal glucose tolerance group, a significantly increased CVD risk was observed in the high-score HPI group, but not in the high-score ICVHMs group (HPI high/medium/low HR, 1.63 [1.22-2.18], 2.19 [1.69-2.83], and 2.26 [1.34 -3.83]; ICVHMs high/medium/low HR, 1.14 [0.47-2.81], 2.38 [1.75-3.23], and 3.31 [2.50-4.38], respectively). Conclusions In diabetes, ideal lifestyle practices alone were insufficient for primary prevention of CVD but had a greater impact on primary prevention of CVD in prediabetes. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-024-00708-7.
Collapse
Affiliation(s)
- Koshiro Murai
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Mayuko Harada Yamada
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Takaho Yamada
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Midori Iwanaga
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Masaru Kitazawa
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Masahiko Yamamoto
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Taeko Osawa
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Yuta Yaguchi
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Satoru Kodama
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| | - Hirohito Sone
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, 951-8510 Japan
| |
Collapse
|
11
|
Valentine Y, Nikolajczyk BS. T cells in obesity-associated inflammation: The devil is in the details. Immunol Rev 2024; 324:25-41. [PMID: 38767210 DOI: 10.1111/imr.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Obesity presents a significant health challenge, affecting 41% of adults and 19.7% of children in the United States. One of the associated health challenges of obesity is chronic low-grade inflammation. In both mice and humans, T cells in circulation and in the adipose tissue play a pivotal role in obesity-associated inflammation. Changes in the numbers and frequency of specific CD4+ Th subsets and their contribution to inflammation through cytokine production indicate declining metabolic health, that is, insulin resistance and T2D. While some Th subset alterations are consistent between mice and humans with obesity, some changes mainly characterize male mice, whereas female mice often resist obesity and inflammation. However, protection from obesity and inflammation is not observed in human females, who can develop obesity-related T-cell inflammation akin to males. The decline in female sex hormones after menopause is also implicated in promoting obesity and inflammation. Age is a second underappreciated factor for defining and regulating obesity-associated inflammation toward translating basic science findings to the clinic. Weight loss in mice and humans, in parallel with these other factors, does not resolve obesity-associated inflammation. Instead, inflammation persists amid modest changes in CD4+ T cell frequencies, highlighting the need for further research into resolving changes in T-cell function after weight loss. How lingering inflammation after weight loss affecting the common struggle to maintain lower weight is unknown. Semaglutide, a newly popular pharmaceutical used for treating T2D and reversing obesity, holds promise for alleviating obesity-associated health complications, yet its impact on T-cell-mediated inflammation remains unexplored. Further work in this area could significantly contribute to the scientific understanding of the impacts of weight loss and sex/hormones in obesity and obesity-associated metabolic decline.
Collapse
Affiliation(s)
- Yolander Valentine
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, Kentucky, USA
| | - Barbara S Nikolajczyk
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, Kentucky, USA
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, Kentucky, USA
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, Kentucky, USA
- Barnstable Brown Diabetes and Obesity Research Center, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
12
|
Capoccia D, Leonetti F, Natali A, Tricò D, Perrini S, Sbraccia P, Guglielmi V. Remission of type 2 diabetes: position statement of the Italian society of diabetes (SID). Acta Diabetol 2024:10.1007/s00592-024-02317-x. [PMID: 38942960 DOI: 10.1007/s00592-024-02317-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/31/2024] [Indexed: 06/30/2024]
Abstract
The primary cause of the pandemic scale of type 2 diabetes (T2D) is the excessive and/or abnormal accumulation of adiposity resulting from a chronic positive energy balance. Any form of weight loss dramatically affects the natural history of T2D, favoring prevention, treatment, and even remission in the case of significant weight loss. However, weight regain, which is often accompanied by the recurrence or worsening of obesity complications such as T2D, is an inevitable biological phenomenon that is an integral part of the pathophysiology of obesity. This can occur not only after weight loss, but also during obesity treatment if it is not effective enough to counteract the physiological responses aimed at restoring adiposity to its pre-weight-loss equilibrium state. Over the past few years, many controlled and randomized studies have suggested a superior efficacy of bariatric surgery compared to conventional therapy in terms of weight loss, glycemic control, and rates of T2D remission. Recently, the therapeutic armamentarium in the field of diabetology has been enriched with new antihyperglycemic drugs with considerable efficacy in reducing body weight, which could play a pathogenetic role in the remission of T2D, not through the classical incretin effect, but by improving adipose tissue functions. All these concepts are discussed in this position statement, which aims to deepen the pathogenetic links between obesity and T2D, shift the paradigm from a "simple" interaction between insulin resistance and insulin deficiency, and evaluate the efficacy of different therapeutic interventions to improve T2D management and induce diabetes remission whenever still possible.
Collapse
Affiliation(s)
- Danila Capoccia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Frida Leonetti
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
| | - Andrea Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sebastio Perrini
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, Unit of Internal Medicine - Obesity Center, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Valeria Guglielmi
- Department of Systems Medicine, Unit of Internal Medicine - Obesity Center, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
13
|
Alver SK, Pan S, Mossavar-Rahmani Y, Sotres-Alvarez D, Evenson KR, Floyd JS, Xanthakis V, Lin J, Cuthbertson C, Gallo LC, Cai J, Penedo FJ, Llabre MM, Matsushita K, Talavera GA, Pirzada A, Spartano N, Daviglus ML, Vasan RS, Kaplan RC. Physical Activity, Cardiovascular Status, Mortality, and Prediabetes in Hispanic and Non-Hispanic Adults. JAMA Netw Open 2024; 7:e2415094. [PMID: 38842811 PMCID: PMC11157354 DOI: 10.1001/jamanetworkopen.2024.15094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/03/2024] [Indexed: 06/07/2024] Open
Abstract
Importance Data are limited on the association of physical activity (PA) with incident cardiovascular disease (CVD) and mortality in prediabetes, especially in racial and ethnic minority groups, including Hispanic and Latino populations. Objective To determine the association of PA with incident CVD and mortality by prediabetes status among Hispanic or Latino and non-Hispanic adults. Design, Setting, and Participants This cohort study included data from 2 cohorts of adults with prediabetes or normoglycemia who were free of CVD at baseline visit: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from baseline examination through 2017, with median (IQR) follow-up of 7.8 (7.2-8.5) years, and the Framingham Heart Study (FHS) with non-Hispanic participants from index examination through 2019, with median (IQR) follow-up of 9.6 (8.1-10.7) years. Analyses were conducted between September 1, 2022, and January 10, 2024. Exposure The primary exposure was baseline accelerometry-measured moderate to vigorous PA, insufficient vs sufficient to meet 2018 Physical Activity Guidelines for Americans (PAG) in both cohorts; additional accelerometer-measured exposures in HCHS/SOL were steps per day, sedentary behavior, and counts per min. Main Outcomes and Measures The outcome was a composite of incident CVD or all-cause mortality, whichever came first. Results This cohort study included 13 223 participants: from HCHS/SOL, there were 9456 adults (all self-identified Hispanic or Latino ethnicity; survey-adjusted mean [SD] age, 38.3 [13.9] years, unweighted counts 5673 (60.0%) female; 4882 [51.6%] with normoglycemia; 4574 [48.4%] with prediabetes), and from FHS there were 3767 adults (3623 [96.2%] non-Hispanic and 140 [3.7%] Hispanic or Latino ethnicity, with 4 [0.1%] participants missing ethnicity; mean [SD] age, 54.2 [13.6] years; 2128 (56.5%) female; 2739 [72.7%] with normoglycemia; 1028 [27.3%] with prediabetes). Not meeting PAG was associated with higher risk of the composite outcome among participants with normoglycemia (vs PAG met; hazard ratio [HR], 1.85 [95% CI, 1.12-3.06]), but not among participants with prediabetes (HR, 1.07 [95% CI, 0.72-1.58]). For HCHS/SOL, no statistically significant association was found between the composite outcome and other PA metrics, although estimated HRs tended to be higher for lower activity in the normoglycemia group but not for the prediabetes group (eg, for steps less than vs at least 7000 per day, the HR was 1.58 [95% CI, 0.85-2.93] for normoglycemia vs 1.08 [95% CI 0.67-1.74] for prediabetes). While there was also no association in HCHS/SOL between the composite outcome and sedentary behavior, results were similar in the prediabetes group (HR per 30 minutes per day of sedentary behavior, 1.05 [95% CI 0.99-1.12]) and in the normoglycemia group (HR, 1.07 [95% CI 0.98-1.16]). Conclusions and Relevance In this cohort study of US Hispanic or Latino and non-Hispanic adults, lower moderate to vigorous PA levels were associated with CVD or mortality among participants with normoglycemia but not participants with prediabetes. Adults with prediabetes may benefit from reducing sedentary behavior and improving multiple lifestyle factors beyond improving moderate to vigorous PA alone.
Collapse
Affiliation(s)
- Sarah K. Alver
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Stephanie Pan
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - James S. Floyd
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Vanessa Xanthakis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts
- Section of Preventive Medicine and Epidemiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Juan Lin
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Carmen Cuthbertson
- Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, California
| | - Jianwen Cai
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Frank J. Penedo
- Department of Medicine, University of Miami, Miami, Florida
- Department of Psychology, University of Miami, Miami, Florida
| | - Maria M. Llabre
- Department of Psychology, University of Miami, Miami, Florida
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Division of Cardiology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago
| | - Nicole Spartano
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago
| | - Ramachandran S. Vasan
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts
- Section of Preventive Medicine and Epidemiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- University of Texas School of Public Health, San Antonio
- University of Texas Health Science Center, San Antonio
| | - Robert C. Kaplan
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
14
|
Giannakogeorgou A, Roden M. Role of lifestyle and glucagon-like peptide-1 receptor agonists for weight loss in obesity, type 2 diabetes and steatotic liver diseases. Aliment Pharmacol Ther 2024; 59 Suppl 1:S52-S75. [PMID: 38813830 DOI: 10.1111/apt.17848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/08/2023] [Accepted: 12/15/2023] [Indexed: 05/31/2024]
Abstract
BACKGROUND The current obesity pandemic has given rise to associated comorbidities and complications, including type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD). During the last decade, certain glucagon-like peptide 1 receptor agonists (GLP-1RA), originally developed as antihyperglycemic drugs, also demonstrated efficacy for weight loss. AIMS To review shared pathophysiologic features of common metabolic diseases and compare therapeutic strategies to reduce body weight and related complications. METHODS We performed an extensive literature research to describe the effects of lifestyle modification, first-generation anti-obesity drugs, and GLP-1RA on weight loss in humans with obesity, type 2 diabetes and MASLD. RESULTS Until recently, treatment of obesity has been limited to lifestyle modification, which offer moderate degree and sustainability of weight loss. The few approved first-generation anti-obesity drugs are either limited to short term use or to certain forms of obesity. Some GLP-1RA significantly decrease caloric intake and body weight. Liraglutide and semaglutide have therefore been approved for treating people with obesity. They also lead to a reduction of hepatic fat content and inflammation in people with biopsy-confirmed MASLD. Possible limitations comprise adverse effects, treatment adherence and persistence. CONCLUSION Certain GLP-1RA are superior to lifestyle modification and first-generation anti-obesity drugs in inducing weight loss. They have therefore markedly changed the portfolio of obesity treatment with additional beneficial effects on steatotic liver disease.
Collapse
Affiliation(s)
- Anna Giannakogeorgou
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, Neuherberg, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany
| |
Collapse
|
15
|
Zhuang Y, Pan X, Chen Y, Song J. Unraveling genetic causality between metformin and myocardial infarction on the basis of Mendelian randomization. Front Endocrinol (Lausanne) 2024; 15:1376464. [PMID: 38765955 PMCID: PMC11099286 DOI: 10.3389/fendo.2024.1376464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Background In recent years, several studies have explored the effect of metformin on myocardial infarction (MI), but whether metformin has an improvement effect in patients with MI is controversial. This study was aimed to investigate the causal relationship between metformin and MI using Mendelian randomization (MR) analysis. Methods The genome-wide significant (P<5×10-8) single-nucleotide polymorphisms (SNPs) in patients with metformin and patients with MI were screened from the Open genome-wide association study (GWAS) project as instrumental variables (IVs). The study outcomes mainly included MI, old MI, acute MI, acute transmural MI of inferior wall, and acute transmural MI of anterior wall. The inverse variance weighted (IVW) method was applied to assess the main causal effect, and weighted median, simple mode, weighted mode methods, and MR-Egger regression were auxiliary applied for supplementary proof. The causal relationship between metformin and MI was assessed using odds ratios (OR) and 95% confidence intervals (95% CI). A leave-one-out method was used to explore the effect of individual SNPs on the results of IVW analyses, and a funnel plot was used to analyze the potential bias of the study results, thus ensuring the robustness of the results. Results In total, 16, 84, 39, 26, and 34 SNPs were selected as IVs to assess the genetic association between metformin and outcomes of MI, old MI, acute MI, acute transmural MI of inferior wall, and acute transmural MI of anterior wall, respectively. Treatment with metformin does not affect the risk of acute transmural MI of anterior wall at the genetic level (P>0.05; OR for inverse variance weighted was 1.010). In the cases of MI, old MI, acute MI, and acute transmural MI of inferior wall, metformin may even be a risk factor for patients (P<0.05; ORs for inverse variance weighted were 1.078, 1.026, 1.022 and 1.018 respectively). There was no horizontal pleiotropy or heterogeneity among IVs. The results were stable when removing the SNPs one by one. Conclusion Metformin is not protective against the risk of myocardial infarction in patients and may even be a risk factor for MI, old MI, acute MI, and acute transmural MI of inferior wall.
Collapse
Affiliation(s)
- Yongru Zhuang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
- Department of Pharmacy, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xiaojun Pan
- Department of Pharmacy, Wuxi No.5 People’s Hospital, Wuxi, China
| | - Ya Chen
- Department of Endocrinology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jinfang Song
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
- Department of Pharmacy, Affiliated Hospital of Jiangnan University, Wuxi, China
| |
Collapse
|
16
|
Chiu CD, Chiu YP, Yip HT, Ji HR, Cho DY, Cheng IHJ, Chen CY. Thiazolidinediones Decrease the Recurrence of Intracerebral Hemorrhage in Type 2 Diabetes Mellitus Patients: A Nested Case-Control Study. Neuroepidemiology 2024:1-14. [PMID: 38705143 DOI: 10.1159/000539001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION Preclinical evidence demonstrated the therapeutic potential of thiazolidinediones (TZDs) for the treatment of intracerebral hemorrhage (ICH). The present study conducted an investigation of cerebrovascular and cardiovascular outcomes following ICH in patients with type 2 diabetes mellitus (T2DM) treated with or without TZDs. METHODS This retrospective nested case-control study used data from the Taiwan National Health Insurance Research Database. A total of 62,515 T2DM patients who were hospitalized with a diagnosis of ICH were enrolled, including 7,603 TZD users. Data for TZD non-users were extracted using propensity score matching. Primary outcomes included death and major adverse cardiovascular events (MACEs), which were defined as a composite of ischemic stroke, hemorrhagic stroke (HS), acute myocardial infarction, and congestive heart failure. Patients aged <20 years with a history of traumatic brain injury or any prior history of MACEs were excluded. RESULTS TZD users had significantly lower MACE risks compared with TZD non-users following ICH (adjusted hazard ratio [aHR]: 0.90, 95% confidence interval [CI]: 0.85-0.94, p < 0.001). The most significant MACE difference reported for TZD users was HS, which possessed lower incidence than in TZD non-users, especially for the events that happened within 3 months following ICH (aHR: 0.74, 95% CI: 0.62-0.89 within 1 month, p < 0.01; aHR: 0.68, 95% CI: 0.54-0.85 between 1 and 3 month). CONCLUSION The use of TZD in patients with T2DM was associated with a lower risk of subsequent HS and mortality following ICH.
Collapse
Affiliation(s)
- Cheng-Di Chiu
- School of Medicine, China Medical University, Taichung, Taiwan,
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan,
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan,
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan,
| | - You-Pen Chiu
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Hei-Tung Yip
- School of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hui-Ru Ji
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Der-Yang Cho
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Irene Han-Juo Cheng
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cho-Yi Chen
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
17
|
Prattichizzo F, Frigé C, Pellegrini V, Scisciola L, Santoro A, Monti D, Rippo MR, Ivanchenko M, Olivieri F, Franceschi C. Organ-specific biological clocks: Ageotyping for personalized anti-aging medicine. Ageing Res Rev 2024; 96:102253. [PMID: 38447609 DOI: 10.1016/j.arr.2024.102253] [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: 12/12/2023] [Revised: 02/11/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Aging is a complex multidimensional, progressive remodeling process affecting multiple organ systems. While many studies have focused on studying aging across multiple organs, assessment of the contribution of individual organs to overall aging processes is a cutting-edge issue. An organ's biological age might influence the aging of other organs, revealing a multiorgan aging network. Recent data demonstrated a similar yet asynchronous inter-organs and inter-individuals progression of aging, thereby providing a foundation to track sources of declining health in old age. The integration of multiple omics with common clinical parameters through artificial intelligence has allowed the building of organ-specific aging clocks, which can predict the development of specific age-related diseases at high resolution. The peculiar individual aging-trajectory, referred to as ageotype, might provide a novel tool for a personalized anti-aging, preventive medicine. Here, we review data relative to biological aging clocks and omics-based data, suggesting different organ-specific aging rates. Additional research on longitudinal data, including young subjects and analyzing sex-related differences, should be encouraged to apply ageotyping analysis for preventive purposes in clinical practice.
Collapse
Affiliation(s)
| | | | | | - Lucia Scisciola
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Aurelia Santoro
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Daniela Monti
- Department of Experimental and Clinical, Biomedical Sciences "Mario Serio" University of Florence, Florence, Italy
| | - Maria Rita Rippo
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Mikhail Ivanchenko
- Institute of Information Technologies, Mathematics and Mechanics, and Institute of Biogerontology, Lobachevsky State University, Nizhny Novgorod 603022, Russia
| | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy; Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy.
| | - Claudio Franceschi
- Institute of Information Technologies, Mathematics and Mechanics, and Institute of Biogerontology, Lobachevsky State University, Nizhny Novgorod 603022, Russia
| |
Collapse
|
18
|
Portal Teixeira P, Pozzer Zucatti K, Strassburger Matzenbacher L, Fink Wayerbacher L, Zhang M, Colpani V, Gerchman F. Long-term lifestyle intervention can reduce the development of type 2 diabetes mellitus in subjects with prediabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2024; 210:111637. [PMID: 38548107 DOI: 10.1016/j.diabres.2024.111637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
AIMS To evaluate the effectiveness of intensive lifestyle intervention (ILI) on the risk of type 2 diabetes (T2D) in prediabetes (PD). METHODS We searched the Cochrane Central, Embase, MEDLINE, and Web of Science (until February 2024) to include RCTs of adults with PD, comparing ILI vs. general advice on the incidence of T2D. Two authors extracted the data, applied the Cochrane Risk of Bias (RoB) 2.0 tool and the GRADE framework. Meta-analysis was performed using random effects models, estimating relative risk (RR) and the 95%CI. RESULTS Fifteen studies (n = 8,563, 46.7 % female, 53.3 ± 8.7 years, BMI 26.7 ± 5.4 Kg/m2) were included. ILI reduced T2D risk by 22 % when compared with general advice (RR 0.78; 95 %CI 0.72-0.85; I2 = 40 %; low certainty of evidence). Most studies had high risk of bias or raised some concerns. Sensitivity analysis showed that studies with mostly female populations and those using the WHO 1985 criteria for T2D had lower risk of the disease and that the longer the follow-up, the lower the protection. CONCLUSION ILI can prevent T2D in subjects with PD. Healthcare teams should aim for structured ILI to maintain long-term lifestyle improvements.
Collapse
Affiliation(s)
- Paula Portal Teixeira
- Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Graduate Program in Medical Sciences: Endocrinology, Department Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Kelly Pozzer Zucatti
- Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Graduate Program in Medical Sciences: Endocrinology, Department Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Laura Fink Wayerbacher
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Minghui Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Verônica Colpani
- Graduate Program in Medical Sciences: Endocrinology, Department Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fernando Gerchman
- Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Graduate Program in Medical Sciences: Endocrinology, Department Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| |
Collapse
|
19
|
Rothberg A, Lean M, Laferrère B. Remission of type 2 diabetes: always more questions, but enough answers for action. Diabetologia 2024; 67:602-610. [PMID: 38189935 PMCID: PMC10904507 DOI: 10.1007/s00125-023-06069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/07/2023] [Indexed: 01/09/2024]
Abstract
The concept of type 2 diabetes remission is evolving rapidly, and gaining wide public and professional interest, following demonstration that with substantial intentional weight loss almost nine in ten people with type 2 diabetes can reduce their HbA1c level below the diagnostic criterion (48 mmol/mol [6.5%]) without glucose-lowering medications, and improve all features of the metabolic syndrome. Pursuing nomoglycaemia with older drugs was dangerous because of the risk of side effects and hypoglycaemia, so the conventional treatment target was an HbA1c concentration of 53 mmol/mol (7%), meaning that diabetes was still present and allowing disease progression. Newer agents may achieve a normal HbA1c safely and, by analogy with treatments that send cancers or inflammatory diseases into remission, this might also be considered remission. However, although modern glucagon-like peptide-1 receptor agonists and related medications are highly effective for weight loss and glycaemic improvement, and generally safe, many people do not want to take drugs indefinitely, and their cost means that they are not available across much of the world. Therefore, there are strong reasons to explore and research dietary approaches for the treatment of type 2 diabetes. All interventions that achieve sustained weight loss of >10-15 kg improve HbA1c, potentially resulting in remission if sufficient beta cell capacity can be preserved or restored, which occurs with loss of the ectopic fat in liver and pancreas that is found with type 2 diabetes. Remission is most likely with type 2 diabetes of short duration, lower HbA1c and a low requirement for glucose-lowering medications. Relapse is likely with weight regain and among those with a poor beta cell reserve. On current evidence, effective weight management should be provided to all people with type 2 diabetes as soon as possible after diagnosis (or even earlier, at the stage of prediabetes, defined in Europe, Australasia, Canada [and most of the world] as ≥42 and <48 mmol/mol [≥6.0 and <6.5%], and in the USA as HbA1c ≥39 and <48 mmol/mol [≥5.7 and <6.5%]). Raising awareness among people with type 2 diabetes and their healthcare providers that remission is possible will enable earlier intervention. Weight loss of >10 kg and remission lasting 1-2 years may also delay vascular complications, although more evidence is needed. The greatest challenge for research is to improve long-term weight loss maintenance, defining cost-effective approaches tailored to the preferences and needs of people living with type 2 diabetes.
Collapse
Affiliation(s)
- Amy Rothberg
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Blandine Laferrère
- Division of Endocrinology, Columbia University Irving Medical Center, New York, NY, USA.
| |
Collapse
|
20
|
Yu L, Wang J, Gong Q, An Y, Chen F, Chen Y, Chen X, He S, Qian X, Chen B, Dong F, Li H, Zhao F, Zhang B, Li G. Influence of a diet and/or exercise intervention on long-term mortality and vascular complications in people with impaired glucose tolerance: Da Qing Diabetes Prevention Outcome study. Diabetes Obes Metab 2024; 26:1188-1196. [PMID: 38168886 DOI: 10.1111/dom.15413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
AIM We aimed to investigate the long-term influence of a diet and/or exercise intervention on long-term mortality and cardiovascular disease (CVD) events. METHODS The Da Qing Diabetes Prevention Study had 576 participants with impaired glucose tolerance (IGT) randomized to diet-only, exercise-only and diet-plus-exercise intervention group and control group. The participants underwent lifestyle interventions for 6 years. The subsequent Da Qing Diabetes Prevention Outcome Study was a prospective cohort study to follow-up the participants for up to 24 years after the end of 6-year intervention. In total, 540 participants completed the follow-up, while 36 subjects lost in follow-up. Cox proportional hazards analysis was applied to assess the influence of lifestyle interventions on targeted outcomes. RESULTS Compared with controls, the diet-only intervention in people with IGT was significantly associated with a reduced risk of all-cause death [hazard ratio (HR) 0.77, 95% confidence interval (CI) (0.61-0.97)], CVD death [HR 0.67, 95% CI (0.46-0.97)] and CVD events [HR 0.72, 95% CI (0.54-0.96)]. The diet-plus-exercise intervention was significantly associated with a decreased risk of all-cause death [HR 0.64, 95% CI (0.48-0.84)], CVD death [HR 0.54, 95% CI (0.30-0.97)] and CVD events [HR 0.68, 95% CI (0.52-0.90)]. Unexpectedly, the exercise-only intervention was not significantly associated with the reduction of any of these outcomes, although there was a consistent trend towards reduction. CONCLUSIONS A diet-only intervention and a diet-plus-exercise intervention in people with IGT were significantly associated with a reduced risk of all-cause death, CVD death and CVD events, while an exercise-only intervention was not. It suggests that diet-related interventions may have a potentially more reliable influence on long-term vascular complications and mortality.
Collapse
Affiliation(s)
- Liping Yu
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Jinping Wang
- Department of Cardiology, Da Qing First Hospital, Da Qing, China
| | - Qiuhong Gong
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yali An
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Chen
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Yanyan Chen
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - XiaoPing Chen
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Siyao He
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Qian
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fen Dong
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Hui Li
- Department of Cardiology, Da Qing First Hospital, Da Qing, China
| | - Fang Zhao
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Bo Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Guangwei Li
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
21
|
Kim C, Kim Y, Sohn JH, Sung JH, Han SW, Lee M, Kim Y, Lee JJ, Mo HJ, Yu KH, Lee SH. Effects of Prior Metformin Use on Stroke Outcomes in Diabetes Patients with Acute Ischemic Stroke Receiving Endovascular Treatment. Biomedicines 2024; 12:745. [PMID: 38672100 PMCID: PMC11048027 DOI: 10.3390/biomedicines12040745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
Diabetes mellitus (DM) predisposes individuals to vascular injury, leading to poor outcomes after ischemic stroke and symptomatic hemorrhagic transformation (SHT) after thrombolytic and endovascular treatment (EVT). Metformin (MET), an oral antidiabetic drug, has shown potential neuroprotective effects, but its impact on stroke prognosis in DM patients undergoing EVT remains unclear. In a multicenter study, 231 patients with DM undergoing EVT for acute ischemic stroke were enrolled. Prior MET use was identified, and patients were stratified into MET+ and MET- groups. Demographics, clinical data, and outcomes were compared between groups. Multivariate analysis was used to assess the effect of MET on stroke prognosis. Of the enrolled patients, 59.3% were previously on MET. MET+ patients had lower initial infarct volumes and NIHSS scores compared to MET-taking patients. Multivariate analysis showed that MET+ was associated with a lower risk of stroke progression and SHT (with stroke progression as follows: odd ratio [OR] 0.24, 95% confidence interval [CI] [0.12-0.48], p < 0.001; SHT: OR 0.33, 95% CI [0.14-0.75], p = 0.01) and was also associated with better 3-month functional outcomes (mRS 0-2) after EVT. Prestroke MET use in DM patients undergoing EVT is associated with improved stroke prognosis, including reduced risk of stroke progression and SHT and better functional outcomes. These findings suggest the potential neuroprotective role of MET in this population and highlight its clinical utility as an adjunctive therapy in the management of ischemic stroke. Further research is warranted to elucidate the underlying mechanisms and to optimize MET therapy in this setting.
Collapse
Affiliation(s)
- Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea; (C.K.); (J.-H.S.); (J.H.S.); (S.-W.H.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24252, Republic of Korea; (Y.K.); (J.J.L.)
| | - Yejin Kim
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24252, Republic of Korea; (Y.K.); (J.J.L.)
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea; (C.K.); (J.-H.S.); (J.H.S.); (S.-W.H.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24252, Republic of Korea; (Y.K.); (J.J.L.)
| | - Joo Hye Sung
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea; (C.K.); (J.-H.S.); (J.H.S.); (S.-W.H.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24252, Republic of Korea; (Y.K.); (J.J.L.)
| | - Sang-Won Han
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea; (C.K.); (J.-H.S.); (J.H.S.); (S.-W.H.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24252, Republic of Korea; (Y.K.); (J.J.L.)
| | - Minwoo Lee
- Department of Neurology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (M.L.); (K.-H.Y.)
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea;
| | - Jae Jun Lee
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24252, Republic of Korea; (Y.K.); (J.J.L.)
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
| | - Hee Jung Mo
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea;
| | - Kyung-Ho Yu
- Department of Neurology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (M.L.); (K.-H.Y.)
| | - Sang-Hwa Lee
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea; (C.K.); (J.-H.S.); (J.H.S.); (S.-W.H.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24252, Republic of Korea; (Y.K.); (J.J.L.)
| |
Collapse
|
22
|
Qi M, Zhang H, Xiu X, He D, Cooper DN, Yang Y, Zhao H. Genetic evidence for T-wave area from 12-lead electrocardiograms to monitor cardiovascular diseases in patients taking diabetes medications. Hum Genet 2024:10.1007/s00439-024-02661-6. [PMID: 38507016 DOI: 10.1007/s00439-024-02661-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024]
Abstract
Aims Many studies indicated use of diabetes medications can influence the electrocardiogram (ECG), which remains the simplest and fastest tool for assessing cardiac functions. However, few studies have explored the role of genetic factors in determining the relationship between the use of diabetes medications and ECG trace characteristics (ETC). Methods Genome-wide association studies (GWAS) were performed for 168 ETCs extracted from the 12-lead ECGs of 42,340 Europeans in the UK Biobank. The genetic correlations, causal relationships, and phenotypic relationships of these ETCs with medication usage, as well as the risk of cardiovascular diseases (CVDs), were estimated by linkage disequilibrium score regression (LDSC), Mendelian randomization (MR), and regression model, respectively. Results The GWAS identified 124 independent single nucleotide polymorphisms (SNPs) that were study-wise and genome-wide significantly associated with at least one ETC. Regression model and LDSC identified significant phenotypic and genetic correlations of T-wave area in lead aVR (aVR_T-area) with usage of diabetes medications (ATC code: A10 drugs, and metformin), and the risks of ischemic heart disease (IHD) and coronary atherosclerosis (CA). MR analyses support a putative causal effect of the use of diabetes medications on decreasing aVR_T-area, and on increasing risk of IHD and CA. ConclusionPatients taking diabetes medications are prone to have decreased aVR_T-area and an increased risk of IHD and CA. The aVR_T-area is therefore a potential ECG marker for pre-clinical prediction of IHD and CA in patients taking diabetes medications.
Collapse
Affiliation(s)
- Mengling Qi
- Department of Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Haoyang Zhang
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, China
| | - Xuehao Xiu
- Department of Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510006, China
| | - Dan He
- Department of Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510006, China
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Yuanhao Yang
- Mater Research Institute, Translational Research Institute, Brisbane, QLD, Australia
| | - Huiying Zhao
- Department of Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510006, China.
| |
Collapse
|
23
|
Shangguan Q, Liu Q, Yang R, Zhang S, Sheng G, Kuang M, Zou Y. Predictive value of insulin resistance surrogates for the development of diabetes in individuals with baseline normoglycemia: findings from two independent cohort studies in China and Japan. Diabetol Metab Syndr 2024; 16:68. [PMID: 38491516 PMCID: PMC10943817 DOI: 10.1186/s13098-024-01307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Insulin resistance (IR) plays a crucial role in the occurrence and progression of diabetes. This study aimed to evaluate and compare the predictive value of four IR surrogates, including the triglycerides glucose (TyG) index, TyG and body mass index (TyG-BMI), triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio, and the metabolic score for IR (MetS-IR) for diabetes in two large cohorts. METHODS A total of 116,661 adult participants from the China Rich Healthcare Group and 15,464 adult participants from the Japanese NAGALA cohort were included in the study. Multivariable Cox proportional hazards models were used to assess the standardized hazard ratio (HR) of the TyG index, TyG-BMI, TG/HDL-C ratio, and MetS-IR directly associated with diabetes. Receiver operating characteristic (ROC) curve and time-dependent ROC curve analysis were performed to evaluate and compare the predictive value of the four IR surrogates for diabetes. RESULTS In the two independent cohorts, the average follow-up time was 3.1 years in the China cohort, with 2681(2.30%) incident cases of diabetes recorded, and 6.13 years in the Japan cohort, with 373 incident cases (2.41%) of diabetes recorded. After adjusting for potential confounding factors, we found that among the four IR surrogates, TyG-BMI and MetS-IR showed stronger associations with diabetes. The stronger associations persisted even after further stratification by age, sex, hypertension, and obese subgroups. In terms of diabetes prediction, based on ROC analysis, TyG-BMI demonstrated the highest predictive accuracy for diabetes in the Chinese population, while both TyG-BMI and MetS-IR showed the highest predictive accuracy in the Japanese population. The results of further subgroup ROC analysis confirmed the robustness of these findings. Furthermore, the time-dependent ROC results indicated that among the four IR surrogates, MetS-IR exhibited the highest accuracy in predicting future diabetes at various time intervals in the Japanese population. CONCLUSION Our findings suggest that evaluating TyG-BMI and MetS-IR as IR surrogates may be the most useful for predicting diabetes events and assessing the risk of developing diabetes in East Asian populations.
Collapse
Affiliation(s)
- Qing Shangguan
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Qiuling Liu
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Ruijuan Yang
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Endocrinology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Shuhua Zhang
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Guotai Sheng
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Maobin Kuang
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China.
| | - Yang Zou
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
| |
Collapse
|
24
|
Sulu C, Yumuk VD. Treat Obesity to Treat Type 2 Diabetes Mellitus. Diabetes Ther 2024; 15:611-622. [PMID: 38310627 PMCID: PMC10942960 DOI: 10.1007/s13300-024-01536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Obesity, a multifactorial, relapsing chronic disease, serves as a gateway to a spectrum of metabolic, cardiovascular, mechanical and mental health problems. Over the last few decades, the global prevalence of obesity has surged nearly threefold, mirroring the escalating rates of type 2 diabetes mellitus (T2DM). This parallel trajectory strongly suggests a cause-and-effect relationship between obesity and T2DM. Extensive research indicates that even modest weight gain elevates the risk of T2DM, favoring the notion of obesity being a root cause. This perspective finds robust support in numerous studies demonstrating the preventive effects of obesity management on the onset of T2DM. Beyond prevention, obesity management has been shown to enhance remission in individuals with T2DM and to decrease microvascular complications, cardiovascular risk factors, renal failure and heart failure. This evidence underpins the urgent need for global initiatives aimed at addressing obesity management as a key strategy in the prevention and management of T2DM and its complications.
Collapse
Affiliation(s)
- Cem Sulu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, No. 53, 34098, Fatih, Istanbul, Turkey
- European Association for the Study of Obesity-Collaborating Center for Obesity Management, Istanbul, Turkey
| | - Volkan Demirhan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, No. 53, 34098, Fatih, Istanbul, Turkey.
- European Association for the Study of Obesity-Collaborating Center for Obesity Management, Istanbul, Turkey.
| |
Collapse
|
25
|
Billingsley HE, Heiston EM, Bellissimo MP, Lavie CJ, Carbone S. Nutritional Aspects to Cardiovascular Diseases and Type 2 Diabetes Mellitus. Curr Cardiol Rep 2024; 26:73-81. [PMID: 38261251 PMCID: PMC10990987 DOI: 10.1007/s11886-023-02018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW In this narrative review, we discuss the current evidence related to the role of dietary interventions to prevent and treat type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). We also propose alternative therapeutic strategies other than weight loss in this population, namely, improvements in cardiorespiratory fitness and its determinants. RECENT FINDINGS While weight loss has been consistently associated with the prevention of T2DM and improvements in glycemic control in those with established diseases, its role in preventing and treating CVD is less clear. In fact, in this setting, improvements in diet quality have provided greater benefits, suggesting that this might represent an alternative, or an even more effective strategy than energy-restriction. Improvements in diet quality, with and without caloric restriction have been shown to improve CVD risk and to prevent the development of T2DM in individuals at risk; however, with regard to glycemic control in patients with T2DM, any dietary intervention resulting in significant weight loss may produce clinically meaningful benefits. Finally, dietary interventions with and without energy restriction that can improve cardiorespiratory fitness, even in absence of weight loss in patients with obesity, should be encouraged.
Collapse
Affiliation(s)
- Hayley E Billingsley
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily M Heiston
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Moriah P Bellissimo
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Salvatore Carbone
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, USA.
| |
Collapse
|
26
|
Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
27
|
Huang Z, Zhuang X, Huang R, Liu M, Xu X, Fan Z, Dai R, Li H, Xiong Z, Guo Y, Liang Q, Liao X. Physical Activity and Weight Loss Among Adults With Type 2 Diabetes and Overweight or Obesity: A Post Hoc Analysis of the Look AHEAD Trial. JAMA Netw Open 2024; 7:e240219. [PMID: 38386318 PMCID: PMC10884882 DOI: 10.1001/jamanetworkopen.2024.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Importance Prior findings from the Look AHEAD trial showed no significant reduction in the risk of cardiovascular events by lifestyle-induced weight loss among individuals with type 2 diabetes (T2D) and overweight or obesity. However, physical activity (PA) may modify the changes in cardiovascular risk associated with weight loss. Objective To examine the joint association of weight loss and PA with the risk of adverse cardiovascular events in patients with T2D and overweight or obesity. Design, Setting, and Participants This cohort study was a post hoc analysis of the Look AHEAD randomized clinical trial, which compared the cardiovascular effects of weight loss by intensive lifestyle intervention vs diabetes support and education among individuals with T2D and overweight or obesity. The study was conducted from June 2001 to September 2012, and participants were patients in the substudy of accelerometry-measured PA from 8 locations in the United States. Data were analyzed from June to August 2023. Exposures Body weight change and accelerometer-derived PA volume across the first 4 years. Main Outcomes and Measures The primary outcome was a composite cardiovascular outcome including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina. Results Among a total of 1229 participants (mean [SD] age, 60 [7] years; 533 male [43%]), 333 (27%) achieved and maintained weight loss for the first 4 years. Among the individuals who maintained weight loss, 105 (32%) maintained high PA volume. During a median of 9.5 years of follow-up, 198 participants (16.1%) experienced the primary outcome. Compared with those with low PA volume and no weight loss (105 [15.8%]), maintaining high PA volume and weight loss was associated with a 61% lower risk of the primary end point (hazard ratio, 0.39; 95% CI, 0.19-0.81; P = .01). However, there was no significant difference in the risk of the primary end point among those with either weight loss only or high PA only. The multiplicative interaction between weight loss and PA for the risk of cardiovascular events was also significant (P for interaction = .01). Conclusions and Relevance In this cohort study, maintaining weight loss and higher PA volume was associated with a lower risk of the composite cardiovascular outcome. The findings suggest that the cardiovascular benefits of PA may vary and be enhanced by weight loss among individuals with T2D and overweight or obesity.
Collapse
Affiliation(s)
- Zihao Huang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaodong Zhuang
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Rihua Huang
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xinghao Xu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Ziyan Fan
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Rongling Dai
- School of Journalism and Communication, Sun Yat-Sen University, Guangzhou, China
| | - Hansheng Li
- School of Critical Studies, University of Glasgow, Glasgow, United Kingdom
| | - Zhenyu Xiong
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Yue Guo
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Qi Liang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xinxue Liao
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
28
|
Lizarzaburu-Robles JC, Herman WH, Garro-Mendiola A, Galdón Sanz-Pastor A, Lorenzo O. Prediabetes and Cardiometabolic Risk: The Need for Improved Diagnostic Strategies and Treatment to Prevent Diabetes and Cardiovascular Disease. Biomedicines 2024; 12:363. [PMID: 38397965 PMCID: PMC10887025 DOI: 10.3390/biomedicines12020363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
The progression from prediabetes to type-2 diabetes depends on multiple pathophysiological, clinical, and epidemiological factors that generally overlap. Both insulin resistance and decreased insulin secretion are considered to be the main causes. The diagnosis and approach to the prediabetic patient are heterogeneous. There is no agreement on the diagnostic criteria to identify prediabetic subjects or the approach to those with insufficient responses to treatment, with respect to regression to normal glycemic values or the prevention of complications. The stratification of prediabetic patients, considering the indicators of impaired fasting glucose, impaired glucose tolerance, or HbA1c, can help to identify the sub-phenotypes of subjects at risk for T2DM. However, considering other associated risk factors, such as impaired lipid profiles, or risk scores, such as the Finnish Diabetes Risk Score, may improve classification. Nevertheless, we still do not have enough information regarding cardiovascular risk reduction. The sub-phenotyping of subjects with prediabetes may provide an opportunity to improve the screening and management of cardiometabolic risk in subjects with prediabetes.
Collapse
Affiliation(s)
- Juan Carlos Lizarzaburu-Robles
- Endocrinology Unit, Hospital Central de la Fuerza Aérea del Perú, 15046 Lima, Peru;
- Doctorate Program, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - William H. Herman
- Department of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA;
| | | | | | - Oscar Lorenzo
- Laboratory of Diabetes and Vascular Pathology, IIS-Fundación Jiménez Díaz, Universidad Autónoma, 28049 Madrid, Spain;
- Biomedical Research Network on Diabetes and Associated Metabolic Disorders (CIBERDEM), Carlos III National Health Institute, 28029 Madrid, Spain
| |
Collapse
|
29
|
Gulanski BI, Goulet JL, Radhakrishnan K, Ko J, Li Y, Rajeevan N, Lee KM, Heberer K, Lynch JA, Streja E, Mutalik P, Cheung KH, Concato J, Shih MC, Lee JS, Aslan M. Metformin prescription for U.S. veterans with prediabetes, 2010-2019. J Investig Med 2024; 72:139-150. [PMID: 37668313 DOI: 10.1177/10815589231201141] [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] [Indexed: 09/06/2023]
Abstract
Affecting an estimated 88 million Americans, prediabetes increases the risk for developing type 2 diabetes mellitus (T2DM), and independently, cardiovascular disease, retinopathy, nephropathy, and neuropathy. Nevertheless, little is known about the use of metformin for diabetes prevention among patients in the Veterans Health Administration, the largest integrated healthcare system in the U.S. This is a retrospective observational cohort study of the proportion of Veterans with incident prediabetes who were prescribed metformin at the Veterans Health Administration from October 2010 to September 2019. Among 1,059,605 Veterans with incident prediabetes, 12,009 (1.1%) were prescribed metformin during an average 3.4 years of observation after diagnosis. Metformin prescribing was marginally higher (1.6%) among those with body mass index (BMI) ≥35 kg/m2, age <60 years, HbA1c≥6.0%, or those with a history of gestational diabetes, all subgroups at a higher risk for progression to T2DM. In a multivariable model, metformin was more likely to be prescribed for those with BMI ≥35 kg/m2 incidence rate ratio [IRR] 2.6 [95% confidence intervals (CI): 2.1-3.3], female sex IRR, 2.4 [95% CI: 1.8-3.3], HbA1c≥6% IRR, 1.93 [95% CI: 1.5-2.4], age <60 years IRR, 1.7 [95% CI: 1.3-2.3], hypertriglyceridemia IRR, 1.5 [95% CI: 1.2-1.9], hypertension IRR, 1.5 [95% CI: 1.1-2.1], Major Depressive Disorder IRR, 1.5 [95% CI: 1.1-2.0], or schizophrenia IRR, 2.1 [95% CI: 1.2-3.8]. Over 20% of Veterans with prediabetes attended a comprehensive structured lifestyle modification clinic or program. Among Veterans with prediabetes, metformin was prescribed to 1.1% overall, a proportion that marginally increased to 1.6% in the subset of individuals at highest risk for progression to T2DM.
Collapse
Affiliation(s)
- Barbara I Gulanski
- Department of Medicine, Endocrinology, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Endocrinology, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph L Goulet
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- Pain, Research, Informatics, Multi-morbidities and Education Center (PRIME), West Haven, CT, USA
| | - Krishnan Radhakrishnan
- National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
| | - John Ko
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Yuli Li
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Nallakkandi Rajeevan
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kyung Min Lee
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Kent Heberer
- VA Palo Alto Cooperative Studies Program Coordinating Center, VA Palo Alto Heath Care System, CA, USA
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Julie A Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elani Streja
- Department of Medicine, Nephrology, Hypertension and Transplant, University of California-Irvine School of Medicine, Long Beach, CA, USA
| | - Pradeep Mutalik
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kei-Hoi Cheung
- Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - John Concato
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Mei-Chiung Shih
- VA Palo Alto Cooperative Studies Program Coordinating Center, VA Palo Alto Heath Care System, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer S Lee
- VA Palo Alto Cooperative Studies Program Coordinating Center, VA Palo Alto Heath Care System, CA, USA
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mihaela Aslan
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
30
|
Denimal D. Antioxidant and Anti-Inflammatory Functions of High-Density Lipoprotein in Type 1 and Type 2 Diabetes. Antioxidants (Basel) 2023; 13:57. [PMID: 38247481 PMCID: PMC10812436 DOI: 10.3390/antiox13010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
(1) Background: high-density lipoproteins (HDLs) exhibit antioxidant and anti-inflammatory properties that play an important role in preventing the development of atherosclerotic lesions and possibly also diabetes. In turn, both type 1 diabetes (T1D) and type 2 diabetes (T2D) are susceptible to having deleterious effects on these HDL functions. The objectives of the present review are to expound upon the antioxidant and anti-inflammatory functions of HDLs in both diabetes in the setting of atherosclerotic cardiovascular diseases and discuss the contributions of these HDL functions to the onset of diabetes. (2) Methods: this narrative review is based on the literature available from the PubMed database. (3) Results: several antioxidant functions of HDLs, such as paraoxonase-1 activity, are compromised in T2D, thereby facilitating the pro-atherogenic effects of oxidized low-density lipoproteins. In addition, HDLs exhibit diminished ability to inhibit pro-inflammatory pathways in the vessels of individuals with T2D. Although the literature is less extensive, recent evidence suggests defective antiatherogenic properties of HDL particles in T1D. Lastly, substantial evidence indicates that HDLs play a role in the onset of diabetes by modulating glucose metabolism. (4) Conclusions and perspectives: impaired HDL antioxidant and anti-inflammatory functions present intriguing targets for mitigating cardiovascular risk in individuals with diabetes. Further investigations are needed to clarify the influence of glycaemic control and nephropathy on HDL functionality in patients with T1D. Furthermore, exploring the effects on HDL functionality of novel antidiabetic drugs used in the management of T2D may provide intriguing insights for future research.
Collapse
Affiliation(s)
- Damien Denimal
- Unit 1231, Center for Translational and Molecular Medicine, University of Burgundy, 21000 Dijon, France;
- Department of Clinical Biochemistry, Dijon Bourgogne University Hospital, 21079 Dijon, France
| |
Collapse
|
31
|
Kwok MK, Schooling CM. Unraveling Potential Sex-Specific Effects of Cardiovascular Medications on Longevity Using Mendelian Randomization. J Am Heart Assoc 2023; 12:e030943. [PMID: 38108247 PMCID: PMC10863757 DOI: 10.1161/jaha.123.030943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/18/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Establishing the sex-specific efficacy of cardiovascular medications is pivotal to evidence-based clinical practice, potentially closing the gender gap in longevity. Trials large enough to establish sex differences are unavailable. This study evaluated sex-specific effects of commonly prescribed cardiovascular medications on lifespan. METHODS AND RESULTS In a two-sample Mendelian randomization study, established genetic variants mimicking effects of lipid-lowering drugs, antihypertensives, and diabetes drugs were applied to genetic associations with lifespan proxied by UK Biobank maternal (n=412 937) and paternal (n=415 311) attained age. Estimates were obtained using inverse variance weighting, with sensitivity analyses where possible. For lipid-lowering drugs, genetically mimicked PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors were associated with longer lifespan, particularly in men (2.39 years per SD low-density lipoprotein cholesterol reduction [95% CI, 0.42-4.36], P for interaction=0.14). Genetically mimicked treatments targeting APOC3, LPL, or possibly LDLR were associated with longer lifespan in both sexes. For antihypertensives, genetically mimicked β-blockers and calcium channel blockers were associated with longer lifespan, particularly in men (P for interaction=0.17 for β-blockers and 0.31 for calcium channel blockers). For diabetes drugs, genetically mimicked metformin was associated with longer lifespan in both sexes. No associations were found for genetically mimicked statins, ezetimibe, or angiotensin-converting enzyme inhibitors. CONCLUSIONS PCSK9 inhibitors, β-blockers, and calcium channel blockers may prolong lifespan in the general population, particularly men. Treatments targeting APOC3, LPL, or LDLR and metformin may be relevant to both sexes. Whether other null findings are attributable to lack of efficacy requires investigation. Further investigation of repurposing should be conducted.
Collapse
Affiliation(s)
- Man Ki Kwok
- School of Nursing and Health Studies, Hong Kong Metropolitan UniversityHong KongChina
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
| | - C. Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
- City University of New York Graduate School of Public Health and Health PolicyNew YorkNY
| |
Collapse
|
32
|
Peres M, Costa HS, Silva MA, Albuquerque TG. The Health Effects of Low Glycemic Index and Low Glycemic Load Interventions on Prediabetes and Type 2 Diabetes Mellitus: A Literature Review of RCTs. Nutrients 2023; 15:5060. [PMID: 38140319 PMCID: PMC10746079 DOI: 10.3390/nu15245060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Diets with a low glycemic index (GI) and a low glycemic load (GL) can improve glycemic control, blood lipids, blood pressure and BMI in prediabetes and type 2 diabetes (T2DM), but evidence regarding other aspects of cardiometabolic health is limited. We searched the literature for RCTs published from 2013 to 2023 and reviewed the evidence on low-GI/GL diets and their effects on different aspects of health in prediabetes and T2DM, aiming to build a report on all relevant outcomes included in the studies. We included 14 RCTs with 1055 participants, who were mostly middle-aged individuals with T2DM. Interventions were mostly low GI and lasted 1-36 months. Low-GI/GL foods and diets showed benefits in terms of short-term glycemic control, weight and adiposity. Longer-term trials would be necessary to determine whether these benefits persist over time and/or lead to lower CVD risk and mortality. Effects on lipid profile were inconsistent. Some studies also reported positive effects of low-GI/GL interventions on blood pressure, inflammatory biomarkers, renal function and gut microbiota composition. Future trials should focus on some of these novel outcome measures, which may provide important insights into the metabolic effects of low-GI diets on individuals with diabetes.
Collapse
Affiliation(s)
- Maria Peres
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
| | - Helena S. Costa
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
- REQUIMTE-LAQV, Faculty of Pharmacy, University of Oporto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Mafalda Alexandra Silva
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
- REQUIMTE-LAQV, Faculty of Pharmacy, University of Oporto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Tânia Gonçalves Albuquerque
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
- REQUIMTE-LAQV, Faculty of Pharmacy, University of Oporto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| |
Collapse
|
33
|
Stumpf MAM, Cercato C, de Melo ME, Santos RD, Mancini MC. Down the rabbit hole: reviewing the evidence for primary prevention of cardiovascular disease in people with obesity. Eur J Prev Cardiol 2023; 30:1895-1905. [PMID: 37648659 DOI: 10.1093/eurjpc/zwad280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023]
Abstract
Obesity is a prevalent chronic disorder and a well-known risk factor for cardiovascular disease. However, the evidence of treating obesity for primary prevention of major cardiovascular events is still scarce and controversial. In this review, we provided a comprehensive description of the current evidence in treating obesity regarding cardiovascular protection. Bariatric surgery appears to be the most robust method to reduce events in people without established cardiovascular disease. High compliance to lifestyle interventions can further reduce cardiovascular risk. Concerning pharmacological therapies, a post hoc analysis from SUSTAIN-6 and a meta-analysis from STEP trials suggest that semaglutide, a GLP-1 receptor agonist, could reduce cardiovascular events in people without established cardiovascular disease. The first study addressed specifically a high-risk population with diabetes and, the second, low- or intermediary-risk individuals without diabetes. Tirzepatide, a novel dual GIP/GLP-1 agonist, although not yet tested in specific cardiovascular outcomes trials, could be an alternative since it induces loss in weight similar to the achieved by bariatric surgery. Therefore, extrapolated data in distinct baseline cardiovascular risk populations suggest that these two drugs could be used in primary prevention with the aim of preventing cardiovascular events, but the grade of this evidence is still low. Specifically designed studies are needed to address this specific topic.
Collapse
Affiliation(s)
- Matheo A M Stumpf
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| | - Cintia Cercato
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| | - Maria E de Melo
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
- Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcio C Mancini
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, Street Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| |
Collapse
|
34
|
Gadde KM, Yin X, Goldberg RB, Orchard TJ, Schlögl M, Dabelea D, Ibebuogu UN, Watson KE, Pi‐Sunyer FX, Crandall JP, Temprosa M, Luchsinger JA. Coronary Artery Calcium and Cognitive Decline in the Diabetes Prevention Program Outcomes Study. J Am Heart Assoc 2023; 12:e029671. [PMID: 37929764 PMCID: PMC10727391 DOI: 10.1161/jaha.123.029671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
Background Our aim was to investigate the association of coronary artery calcium (CAC) with cognitive function in adults with impaired glucose tolerance or type 2 diabetes. Methods and Results The Diabetes Prevention Program was a randomized controlled trial comparing an intensive lifestyle intervention, metformin, or placebo for prevention of type 2 diabetes among patients with prediabetes. After 3 years, intensive lifestyle intervention and placebo were stopped, the metformin arm was unmasked, and participants continued in the DPPOS (Diabetes Prevention Program Outcomes Study). Approximately 14 years after randomization (Y14), CAC (Agatston score) was assessed with computed tomography, and cognitive performance was assessed with the Spanish English Verbal Learning Test (SEVLT) and Digit Symbol Substitution Test. SEVLT and Digit Symbol Substitution Test were reassessed 5 years later (Y19) along with the Modified Mini-Mental State Exam. We examined cross-sectional and longitudinal associations between CAC and cognition among 1931 participants using linear and logistic regression. In unadjusted analyses, compared with no calcification, CAC score >300 was associated with decreased performance on all cognitive tests at Y14 in both sexes. Additionally, CAC >300 was associated with a greater 5-year decline in SEVLT Immediate Recall in both sexes and SEVLT Delayed Recall in women. After adjustment for demographic, genetic, metabolic, vascular, and behavioral covariates, CAC score >300 remained associated with greater decline in only SEVLT Delayed Recall in women. Conclusions In women with prediabetes or diabetes, CAC >300, compared with no calcification, was independently associated with greater decline in verbal memory. Registration information clinicaltrials.gov. Identifier: NCT00038727.
Collapse
Affiliation(s)
- Kishore M. Gadde
- Department of SurgeryUniversity of California, Irvine (UCI) Medical CenterOrangeCA
| | - Xiaoyan Yin
- Department of Biostatistics and BioinformaticsGeorge Washington University Biostatistics CenterRockvilleMD
| | - Ronald B. Goldberg
- Diabetes Research Institute, University of Miami Miller School of MedicineMiamiFL
| | | | - Mathias Schlögl
- Division of Geriatric Medicine, Clinic BarmelweidBarmelweidSwitzerland
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) CenterUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Uzoma N. Ibebuogu
- Department of MedicineUniversity of Tennessee Health Science CenterMemphisTN
| | - Karol E. Watson
- Department of Medicine, David Geffen School of Medicine at UCLALos AngelesCA
| | | | - Jill P. Crandall
- Department of Medicine, Albert Einstein College of MedicineBronxNY
| | - Marinella Temprosa
- Department of Biostatistics and BioinformaticsGeorge Washington University Biostatistics CenterRockvilleMD
| | | | | |
Collapse
|
35
|
Gorin SS, Hirko K. Primary Prevention of Cancer: A Multilevel Approach to Behavioral Risk Factor Reduction in Racially and Ethnically Minoritized Groups. Cancer J 2023; 29:354-361. [PMID: 37963370 DOI: 10.1097/ppo.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Cancer continues to be the second most common cause of death in the United States. Racially and ethnically minoritized populations continue to experience disparities in cancer prevention compared with majority populations. Multilevel interventions-from policy, communities, health care institutions, clinical teams, families, and individuals-may be uniquely suited to reducing health disparities through behavioral risk factor modification in these populations. The aim of this article is to provide a brief overview of the evidence for primary prevention among racially and ethnically minoritized subpopulations in the United States. We focus on the epidemiology of tobacco use, obesity, diet and physical activity, alcohol use, sun exposure, and smoking, as well as increasing uptake of the Human Papillomavirus Vaccine (HPV), as mutable behavioral risk factors. We describe interventions at the policy level, including raising excise taxes on tobacco products; within communities and with community partners, for safe greenways and parks, and local healthful food; health care institutions, with reminder systems for HPV vaccinations; among clinicians, by screening for alcohol use and providing tailored weight reduction approaches; families, with HPV education; and among individuals, routinely using sun protection. A multilevel approach to primary prevention of cancer can modify many of the risk factors in racially and ethnically minoritized populations for whom cancer is already a burden.
Collapse
Affiliation(s)
- Sherri Sheinfeld Gorin
- From the Department of Family Medicine, The School of Medicine, and the School of Public Health, The University of Michigan, Ann Arbor, MI
| | - Kelly Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
| |
Collapse
|
36
|
Carris NW, Bunnell BE, Mhaskar R, DuCoin CG, Stern M. A Systematic Approach to Treating Early Metabolic Disease and Prediabetes. Diabetes Ther 2023; 14:1595-1607. [PMID: 37543535 PMCID: PMC10499776 DOI: 10.1007/s13300-023-01455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/19/2023] [Indexed: 08/07/2023] Open
Abstract
At least 70% of US adults have metabolic disease. However, less is done to address early disease (e.g., overweight, obesity, prediabetes) versus advanced disease (e.g., type 2 diabetes mellitus, coronary artery disease). Given the burden of advanced metabolic disease and the burgeoning pandemics of obesity and prediabetes a systematic response is required. To accomplish this, we offer several recommendations: (A) Patients with overweight, obesity, and/or prediabetes must be consistently diagnosed with these conditions in medical records to enable population health initiatives. (B) Patients with early metabolic disease should be offered in-person or virtual lifestyle interventions commensurate with the findings of the Diabetes Prevention Program. (C) Patients unable to participate in or otherwise failing lifestyle intervention must be screened to assess if they require pharmacotherapy. (D) Patients not indicated for, refusing, or failing pharmacotherapy must be screened to assess if they need bariatric surgery. (E) Regardless of treatment approach or lack of treatment, patients must be consistently screened for the progression of early metabolic disease to advanced disease to enable early control. Progression of metabolic disease from an overweight yet otherwise healthy person includes the development of prediabetes, obesity ± prediabetes, dyslipidemia, hypertension, type 2 diabetes, chronic kidney disease, coronary artery disease, and heart failure. Systematic approaches in health systems must be deployed with clear protocols and supported by streamlined technologies to manage their population's metabolic health from early through advanced metabolic disease. Additional research is needed to identify and validate optimal system-level interventions. Future research needs to identify strategies to roll out systematic interventions for the treatment of early metabolic disease and to improve the metabolic health among the progressively younger patients being impacted by obesity and diabetes.
Collapse
Affiliation(s)
- Nicholas W Carris
- Department of Pharmacotherapeutics and Clinical Research, Taneja College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd MDC 30, Tampa, FL, 33612, USA.
| | - Brian E Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Christopher G DuCoin
- Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| |
Collapse
|
37
|
Maki KC, Kirkpatrick CF, Allison DB, Gadde KM. Pharmacotherapy for obesity: recent evolution and implications for cardiovascular risk reduction. Expert Rev Endocrinol Metab 2023; 18:307-319. [PMID: 37199542 DOI: 10.1080/17446651.2023.2209176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Obesity is highly prevalent in the U.S. and is associated with an increased risk of major adverse cardiovascular events (MACE). Modalities for the management of obesity include lifestyle intervention, pharmacotherapy, and bariatric surgery. AREAS COVERED This review describes the evidence on the effects of weight loss therapies on MACE risk. Lifestyle interventions and older antiobesity pharmacotherapies have been associated with <12% body weight reduction and no clear benefit to reduce MACE risk. Bariatric surgery is associated with substantial weight reduction (20-30%) and markedly lower subsequent risk for MACE. Newer antiobesity pharmacotherapies, particularly semaglutide and tirzepatide, have shown greater efficacy for weight reduction compared with older medications and are being evaluated in cardiovascular outcomes trials. EXPERT OPINION Current practice for cardiovascular risk reduction in patients with obesity is lifestyle intervention for weight loss, combined with the treatment of obesity-related cardiometabolic risk factors individually. The use of medications to treat obesity is relatively rare. In part, this reflects concerns about long-term safety and weight loss effectiveness, possible provider bias, as well as lack of clear evidence of MACE risk reduction. If ongoing outcomes trials demonstrate the efficacy of newer agents in reducing MACE risk, this will likely lead to expanded use in obesity management.
Collapse
Affiliation(s)
- Kevin C Maki
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
- Midwest Biomedical Research, Addison, IL, USA
| | - Carol F Kirkpatrick
- Midwest Biomedical Research, Addison, IL, USA
- Idaho State University, Pocatello, ID, USA
| | - David B Allison
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | | |
Collapse
|
38
|
Molitch ME, Tripputi M, Levey AS, Crandall JP, Dabelea D, Herman WH, Knowler WC, Orchard TJ, Schroeder EB, Srikanthan P, Temprosa M, White NH, Nathan DM. Effects of metformin and intensive lifestyle interventions on the incidence of kidney disease in adults in the DPP/DPPOS. J Diabetes Complications 2023; 37:108556. [PMID: 37607422 PMCID: PMC11017540 DOI: 10.1016/j.jdiacomp.2023.108556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 08/24/2023]
Abstract
AIMS We analyzed the incidence of kidney disease in the Diabetes Prevention Program Outcomes Study (DPPOS) by originally randomized treatment group assignment: Intensive Lifestyle (ILS), Metformin (MET) or Placebo (PLB). METHODS The current analyses used a time-to-event approach in which the primary outcome was kidney disease, ascertained as urine albumin-to-creatinine ratio (ACR) ≥ 3.39 mg/mmol (30 mg/g) or eGFR <45 mL/min/1.73m2, with confirmation required at the next visit, or adjudicated end-stage kidney disease (ESKD). RESULTS At a median of 21 years following randomization in DPP, diabetes development was reduced in both the ILS (HR 0.73 [95%CI = 0.62, 0.85]) and MET groups (HR 0.85 [0.73, 0.99]) compared to the PLB group. Although risk for developing the primary kidney disease outcome was higher among those with incident diabetes compared to those without (HR 1.81 [1.43, 2.30]), it did not differ by intervention groups (ILS vs. PLB 1.02 (0.81, 1.29); MET vs. PLB 1.08 (0.86, 1.35). There was a non-significant metformin by age interaction (p = 0.057), with metformin being beneficial for kidney disease in the younger but potentially harmful in the older participants. CONCLUSIONS Development of kidney disease was increased in participants who developed diabetes but did not differ by original treatment group assignment. CLINICAL TRIAL REGISTRATIONS Diabetes Prevention Program (DPP) Clinical trial reg. no. NCT00004992 DPP Outcomes Study (DPPOS) Clinical trial reg. no. NCT0038727.
Collapse
Affiliation(s)
- Mark E Molitch
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Mark Tripputi
- DPP/DPPOS Coordinating Center, Biostatistics Center, The George Washington University, Rockville, MD, United States of America
| | - Andrew S Levey
- Tufts Medical Center, Boston, MA, United States of America
| | - Jill P Crandall
- Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Dana Dabelea
- Colorado School of Public Health, University of Colorado, Denver, CO, United States of America
| | - William H Herman
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - William C Knowler
- DPP/DPPOS Coordinating Center, Biostatistics Center (Consultant), The George Washington University, Rockville, MD, United States of America
| | - Trevor J Orchard
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America
| | - Emily B Schroeder
- Division of Endocrinology, Parkview Health, Fort Wayne, IN, United States of America
| | - Preethi Srikanthan
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Marinella Temprosa
- DPP/DPPOS Coordinating Center, Biostatistics Center, The George Washington University, Rockville, MD, United States of America.
| | - Neil H White
- Washington University School of Medicine, St. Louis, MO, United States of America
| | - David M Nathan
- Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
39
|
Osorio-Llanes E, Villamizar-Villamizar W, Ospino Guerra MC, Díaz-Ariza LA, Castiblanco-Arroyave SC, Medrano L, Mengual D, Belón R, Castellar-López J, Sepúlveda Y, Vásquez-Trincado C, Chang AY, Bolívar S, Mendoza-Torres E. Effects of Metformin on Ischemia/Reperfusion Injury: New Evidence and Mechanisms. Pharmaceuticals (Basel) 2023; 16:1121. [PMID: 37631036 PMCID: PMC10459572 DOI: 10.3390/ph16081121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
The search for new drugs with the potential to ensure therapeutic success in the treatment of cardiovascular diseases has become an essential pathway to follow for health organizations and committees around the world. In June 2021, the World Health Organization listed cardiovascular diseases as one of the main causes of death worldwide, representing 32% of them. The most common is coronary artery disease, which causes the death of cardiomyocytes, the cells responsible for cardiac contractility, through ischemia and subsequent reperfusion, which leads to heart failure in the medium and short term. Metformin is one of the most-used drugs for the control of diabetes, which has shown effects beyond the control of hyperglycemia. Some of these effects are mediated by the regulation of cellular energy metabolism, inhibiting apoptosis, reduction of cell death through regulation of autophagy and reduction of mitochondrial dysfunction with further reduction of oxidative stress. This suggests that metformin may attenuate left ventricular dysfunction induced by myocardial ischemia; preclinical and clinical trials have shown promising results, particularly in the setting of acute myocardial infarction. This is a review of the molecular and pharmacological mechanisms of the cardioprotective effects of metformin during myocardial ischemia-reperfusion injury.
Collapse
Affiliation(s)
- Estefanie Osorio-Llanes
- Advanced Biomedicine Research Group, Faculty of Health Sciences, Universidad Libre de Colombia, Seccional Barranquilla, Barranquilla 081001, Colombia; (E.O.-L.); (W.V.-V.); (M.C.O.G.); (L.A.D.-A.); (S.C.C.-A.); (R.B.); (J.C.-L.)
- Allied Research Society S.A.S., Barranquilla 080001, Colombia;
- Global Disease Research Colombia, Barranquilla 080001, Colombia
| | - Wendy Villamizar-Villamizar
- Advanced Biomedicine Research Group, Faculty of Health Sciences, Universidad Libre de Colombia, Seccional Barranquilla, Barranquilla 081001, Colombia; (E.O.-L.); (W.V.-V.); (M.C.O.G.); (L.A.D.-A.); (S.C.C.-A.); (R.B.); (J.C.-L.)
| | - María Clara Ospino Guerra
- Advanced Biomedicine Research Group, Faculty of Health Sciences, Universidad Libre de Colombia, Seccional Barranquilla, Barranquilla 081001, Colombia; (E.O.-L.); (W.V.-V.); (M.C.O.G.); (L.A.D.-A.); (S.C.C.-A.); (R.B.); (J.C.-L.)
| | - Luis Antonio Díaz-Ariza
- Advanced Biomedicine Research Group, Faculty of Health Sciences, Universidad Libre de Colombia, Seccional Barranquilla, Barranquilla 081001, Colombia; (E.O.-L.); (W.V.-V.); (M.C.O.G.); (L.A.D.-A.); (S.C.C.-A.); (R.B.); (J.C.-L.)
| | - Sara Camila Castiblanco-Arroyave
- Advanced Biomedicine Research Group, Faculty of Health Sciences, Universidad Libre de Colombia, Seccional Barranquilla, Barranquilla 081001, Colombia; (E.O.-L.); (W.V.-V.); (M.C.O.G.); (L.A.D.-A.); (S.C.C.-A.); (R.B.); (J.C.-L.)
| | - Luz Medrano
- Healthcare Pharmacy and Pharmacology Research Group, Faculty of Chemistry and Pharmacy, Universidad del Atlántico, Barranquilla 081007, Colombia; (L.M.); (D.M.); (S.B.)
| | - Daniela Mengual
- Healthcare Pharmacy and Pharmacology Research Group, Faculty of Chemistry and Pharmacy, Universidad del Atlántico, Barranquilla 081007, Colombia; (L.M.); (D.M.); (S.B.)
| | - Ricardo Belón
- Advanced Biomedicine Research Group, Faculty of Health Sciences, Universidad Libre de Colombia, Seccional Barranquilla, Barranquilla 081001, Colombia; (E.O.-L.); (W.V.-V.); (M.C.O.G.); (L.A.D.-A.); (S.C.C.-A.); (R.B.); (J.C.-L.)
| | - Jairo Castellar-López
- Advanced Biomedicine Research Group, Faculty of Health Sciences, Universidad Libre de Colombia, Seccional Barranquilla, Barranquilla 081001, Colombia; (E.O.-L.); (W.V.-V.); (M.C.O.G.); (L.A.D.-A.); (S.C.C.-A.); (R.B.); (J.C.-L.)
| | - Yanireth Sepúlveda
- Allied Research Society S.A.S., Barranquilla 080001, Colombia;
- Global Disease Research Colombia, Barranquilla 080001, Colombia
| | - César Vásquez-Trincado
- Escuela de Química y Farmacia, Facultad de Medicina, Universidad Andres Bello, Santiago 8370134, Chile;
| | - Aileen Y. Chang
- Department of Medicine, Faculty of Medicine, Foggy Bottom Campus, George Washington University, Washington, DC 20052, USA;
| | - Samir Bolívar
- Healthcare Pharmacy and Pharmacology Research Group, Faculty of Chemistry and Pharmacy, Universidad del Atlántico, Barranquilla 081007, Colombia; (L.M.); (D.M.); (S.B.)
| | - Evelyn Mendoza-Torres
- Advanced Biomedicine Research Group, Faculty of Health Sciences, Universidad Libre de Colombia, Seccional Barranquilla, Barranquilla 081001, Colombia; (E.O.-L.); (W.V.-V.); (M.C.O.G.); (L.A.D.-A.); (S.C.C.-A.); (R.B.); (J.C.-L.)
| |
Collapse
|
40
|
Zhao M, Feng R, Werth VP, Williams KJ. State of current management of the heightened risk for atherosclerotic cardiovascular events in an established cohort of patients with lupus erythematosus. Lupus Sci Med 2023; 10:e000908. [PMID: 37604650 PMCID: PMC10445381 DOI: 10.1136/lupus-2023-000908] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Patients with lupus erythematosus (LE) are at heightened risk for clinical events, chiefly heart attacks and strokes, from atherosclerotic cardiovascular disease (ASCVD). We recently proposed new guidelines to assess and manage ASCVD event risk specifically in LE. Here, we examined current cardiovascular management in light of these new recommendations. METHODS We studied our entire UPenn Longitudinal Lupus Cohort of patients with cutaneous LE, without (CLE-only) or with (CLE+SLE) concurrent systemic LE, for whom we had full access to medical records (n=370, LE-ASCVD Study Cohort). RESULTS Of our LE-ASCVD Study Cohort, 336 out of 370 (90.8%) had a designated primary-care physician. By the new guidelines, the most recent low-density lipoprotein (LDL) levels were above-goal for 249 out of 370 (67.3%). Two-hundred sixty-six (71.9%) had hypertension, which was undertreated or untreated in 198 out of 266 (74.4%). Of current smokers, 51 out of 63 (81.0%) had no documented smoking cessation counselling or referrals. Diabetes and triglyceridaemia were generally well managed. Of the cohort, 278 qualified for two widely used online estimators of ASCVD event risk in primary prevention: the ACC-ASCVD Risk Estimator Plus and QRisk3. We also stratified these 278 patients into our recently defined categories of ASCVD event risk in LE. These three methods for estimating ASCVD event risk showed clinically meaningful discordance for 169 out of 278 (60.8%). The documented rate of ASCVD events in the first 10 years after enrolment was 13.5% (95% CI 8.9%, 17.9%), similar between CLE-only and CLE+SLE, indicating an at-risk population despite the preponderance of women and an average age at enrolment of only 47 years. CONCLUSION Patients with CLE-only or CLE+SLE are undertreated compared with the new guidelines and, accordingly, they experience a significant burden of ASCVD events. Moreover, it is unclear how to accurately assess their future ASCVD event risk, except that it is substantial. Efforts are underway to improve ASCVD event risk estimation and guideline implementation in patients with lupus.
Collapse
Affiliation(s)
- Megan Zhao
- Corporal Michael J. Crescenz Veterans' Administration Medical Center, Philadelphia, Pennsylvania, USA
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rui Feng
- Department of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans' Administration Medical Center, Philadelphia, Pennsylvania, USA
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kevin Jon Williams
- Department of Cardiovascular Sciences, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
41
|
Ciaraldi TP, Boeder SC, Mudaliar SR, Giovannetti ER, Henry RR, Pettus JH. Astaxanthin, a natural antioxidant, lowers cholesterol and markers of cardiovascular risk in individuals with prediabetes and dyslipidaemia. Diabetes Obes Metab 2023; 25:1985-1994. [PMID: 36999233 PMCID: PMC10740106 DOI: 10.1111/dom.15070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/01/2023]
Abstract
AIM To determine the effects of astaxanthin treatment on lipids, cardiovascular disease (CVD) markers, glucose tolerance, insulin action and inflammation in individuals with prediabetes and dyslipidaemia. MATERIALS AND METHODS Adult participants with dyslipidaemia and prediabetes (n = 34) underwent baseline blood draw, an oral glucose tolerance test and a one-step hyperinsulinaemic-euglycaemic clamp. They were then randomized (n = 22 treated, 12 placebo) to receive astaxanthin 12 mg daily or placebo for 24 weeks. Baseline studies were repeated after 12 and 24 weeks of therapy. RESULTS After 24 weeks, astaxanthin treatment significantly decreased low-density lipoprotein (-0.33 ± 0.11 mM) and total cholesterol (-0.30 ± 0.14 mM) (both P < .05). Astaxanthin also reduced levels of the CVD risk markers fibrinogen (-473 ± 210 ng/mL), L-selectin (-0.08 ± 0.03 ng/mL) and fetuin-A (-10.3 ± 3.6 ng/mL) (all P < .05). While the effects of astaxanthin treatment did not reach statistical significance, there were trends toward improvements in the primary outcome measure, insulin-stimulated, whole-body glucose disposal (+0.52 ± 0.37 mg/m2 /min, P = .078), as well as fasting [insulin] (-5.6 ± 8.4 pM, P = .097) and HOMA2-IR (-0.31 ± 0.16, P = .060), suggesting improved insulin action. No consistent significant differences from baseline were observed for any of these outcomes in the placebo group. Astaxanthin was safe and well tolerated with no clinically significant adverse events. CONCLUSIONS Although the primary endpoint did not meet the prespecified significance level, these data suggest that astaxanthin is a safe over-the-counter supplement that improves lipid profiles and markers of CVD risk in individuals with prediabetes and dyslipidaemia.
Collapse
Affiliation(s)
- Theodore P. Ciaraldi
- Department of Medicine, Division of Endocrinology & Metabolism, University of California, San Diego, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Schafer C. Boeder
- Department of Medicine, Division of Endocrinology & Metabolism, University of California, San Diego, La Jolla, CA
| | - Sunder R. Mudaliar
- Department of Medicine, Division of Endocrinology & Metabolism, University of California, San Diego, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Erin R. Giovannetti
- Department of Medicine, Division of Endocrinology & Metabolism, University of California, San Diego, La Jolla, CA
| | - Robert R. Henry
- Department of Medicine, Division of Endocrinology & Metabolism, University of California, San Diego, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Jeremy H. Pettus
- Department of Medicine, Division of Endocrinology & Metabolism, University of California, San Diego, La Jolla, CA
| |
Collapse
|
42
|
Pandey A, Khan MS, Patel KV, Bhatt DL, Verma S. Predicting and preventing heart failure in type 2 diabetes. Lancet Diabetes Endocrinol 2023:S2213-8587(23)00128-6. [PMID: 37385290 DOI: 10.1016/s2213-8587(23)00128-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 07/01/2023]
Abstract
The burden of heart failure among people with type 2 diabetes is increasing globally. People with comorbid type 2 diabetes and heart failure often have worse outcomes than those with only one of these conditions-eg, higher hospitalisation and mortality rates. Therefore, it is essential to implement optimal heart failure prevention strategies for people with type 2 diabetes. A detailed understanding of the pathophysiology underlying the occurrence of heart failure in type 2 diabetes can aid clinicians in identifying relevant risk factors and lead to early interventions that can help prevent heart failure. In this Review, we discuss the pathophysiology and risk factors of heart failure in type 2 diabetes. We also review the risk assessment tools for predicting heart failure incidence in people with type 2 diabetes as well as the data from clinical trials that have assessed the efficacy of lifestyle and pharmacological interventions. Finally, we discuss the potential challenges in implementing new management approaches and offer pragmatic recommendations to help overcome these challenges.
Collapse
Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
43
|
Abstract
Importance Prediabetes, an intermediate stage between normal glucose regulation and diabetes, affects 1 in 3 adults in the US and approximately 720 million individuals worldwide. Observations Prediabetes is defined by a fasting glucose level of 100 to 125 mg/dL, a glucose level of 140 to 199 mg/dL measured 2 hours after a 75-g oral glucose load, or glycated hemoglobin level (HbA1C) of 5.7% to 6.4% or 6.0% to 6.4%. In the US, approximately 10% of people with prediabetes progress to having diabetes each year. A meta-analysis found that prediabetes at baseline was associated with increased mortality and increased cardiovascular event rates (excess absolute risk, 7.36 per 10 000 person-years for mortality and 8.75 per 10 000 person-years for cardiovascular disease during 6.6 years). Intensive lifestyle modification, consisting of calorie restriction, increased physical activity (≥150 min/wk), self-monitoring, and motivational support, decreased the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period. Metformin decreased the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years. Metformin is most effective for women with prior gestational diabetes and for individuals younger than 60 years with body mass index of 35 or greater, fasting plasma glucose level of 110 mg/dL or higher, or HbA1c level of 6.0% or higher. Conclusions and Relevance Prediabetes is associated with increased risk of diabetes, cardiovascular events, and mortality. First-line therapy for prediabetes is lifestyle modification that includes weight loss and exercise or metformin. Lifestyle modification is associated with a larger benefit than metformin.
Collapse
Affiliation(s)
- Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Leigh Perreault
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora
| | - Linong Ji
- Department of Endocrinology, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Sam Dagogo-Jack
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis
| |
Collapse
|
44
|
Prädiabetes: Lebensstilumstellung und/oder Metformin ohne Einfluss auf CV-Risiko? AKTUELLE KARDIOLOGIE 2023. [DOI: 10.1055/a-1923-1758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
|
45
|
Khan J, Pernicova I, Nisar K, Korbonits M. Mechanisms of ageing: growth hormone, dietary restriction, and metformin. Lancet Diabetes Endocrinol 2023; 11:261-281. [PMID: 36848915 DOI: 10.1016/s2213-8587(23)00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 03/01/2023]
Abstract
Tackling the mechanisms underlying ageing is desirable to help to extend the duration and improve the quality of life. Life extension has been achieved in animal models by suppressing the growth hormone-insulin-like growth factor 1 (IGF-1) axis and also via dietary restriction. Metformin has become the focus of increased interest as a possible anti-ageing drug. There is some overlap in the postulated mechanisms of how these three approaches could produce anti-ageing effects, with convergence on common downstream pathways. In this Review, we draw on evidence from both animal models and human studies to assess the effects of suppression of the growth hormone-IGF-1 axis, dietary restriction, and metformin on ageing.
Collapse
Affiliation(s)
- Jansher Khan
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ida Pernicova
- Endocrinology and Metabolic Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kiran Nisar
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| |
Collapse
|
46
|
Dihoum A, Rena G, Pearson ER, Lang CC, Mordi IR. Metformin: evidence from preclinical and clinical studies for potential novel applications in cardiovascular disease. Expert Opin Investig Drugs 2023; 32:291-299. [PMID: 36972373 DOI: 10.1080/13543784.2023.2196010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION For a long time, metformin has been the first-line treatment for glycaemic control in type 2 diabetes, however, the results of recent cardiovascular outcome trials of sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists have caused many to question metformin's position in the guidelines. Although there are several plausible mechanisms by which metformin might have beneficial cardiovascular effects, for example its anti-inflammatory effects and metabolic properties, and numerous observational data suggesting improved cardiovascular outcomes with metformin use, the main randomised clinical trial data for metformin was published over 20 years ago. Nevertheless, the overwhelming majority of participants in contemporary type 2 diabetes trials were prescribed metformin. AREAS COVERED In this review we will summarise the potential mechanisms of cardiovascular benefit with metformin, before discussing clinical data in individuals with or without diabetes. EXPERT OPINION Metformin may have some cardiovascular benefit in patients with and without diabetes, however the majority of clinical trials were small and are before the use SGLT2 inhibitors and GLP1-RAs. Larger contemporary randomised trials with metformin evaluating its cardiovascular benefit are warranted.
Collapse
Affiliation(s)
- Adel Dihoum
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom
| | - Graham Rena
- Division of Cellular Medicine, University of Dundee, Dundee, United Kingdom
| | - Ewan R Pearson
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom
| |
Collapse
|
47
|
Bays HE, Bindlish S, Clayton TL. Obesity, diabetes mellitus, and cardiometabolic risk: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2023. OBESITY PILLARS (ONLINE) 2023; 5:100056. [PMID: 37990743 PMCID: PMC10661981 DOI: 10.1016/j.obpill.2023.100056] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of type 2 diabetes mellitus (T2DM), an obesity-related cardiometabolic risk factor. Methods The scientific support for this CPS is based upon published citations and clinical perspectives of OMA authors. Results Topics include T2DM and obesity as cardiometabolic risk factors, definitions of obesity and adiposopathy, and mechanisms for how obesity causes insulin resistance and beta cell dysfunction. Adipose tissue is an active immune and endocrine organ, whose adiposopathic obesity-mediated dysfunction contributes to metabolic abnormalities often encountered in clinical practice, including hyperglycemia (e.g., pre-diabetes mellitus and T2DM). The determination as to whether adiposopathy ultimately leads to clinical metabolic disease depends on crosstalk interactions and biometabolic responses of non-adipose tissue organs such as liver, muscle, pancreas, kidney, and brain. Conclusions This review is intended to assist clinicians in the care of patients with the disease of obesity and T2DM. This CPS provides a simplified overview of how obesity may cause insulin resistance, pre-diabetes, and T2DM. It also provides an algorithmic approach towards treatment of a patient with obesity and T2DM, with "treat obesity first" as a priority. Finally, treatment of obesity and T2DM might best focus upon therapies that not only improve the weight of patients, but also improve the health outcomes of patients (e.g., cardiovascular disease and cancer).
Collapse
Affiliation(s)
- Harold Edward Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
| | - Shagun Bindlish
- Diabetology, One Medical, Adjunct Faculty Touro University, CA, USA
| | | |
Collapse
|
48
|
Lin HJ, Wang J, Tseng PY, Fu LC, Lee YC, Wu MS, Yang WS, Chiu HM. Lower-than-normal glycemic levels to achieve optimal reduction of diabetes risk among individuals with prediabetes: A prospective cohort study. Diabetes Res Clin Pract 2023; 197:110567. [PMID: 36740021 DOI: 10.1016/j.diabres.2023.110567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
AIMS/HYPOTHESIS To determine whether lower than currently accepted glycemic levels could lead to optimal risk reduction of incident diabetes among individuals with prediabetes. METHODS We enrolled 9903 individuals with prediabetes and 16,902 individuals with normoglycemia from a prospective cohort participating health check-ups between 2006 and 2017. While classifying fasting glucose into <5.0, 5.0-5.5, and 5.6-6.9 mmol/L and postprandial glucose into <6.7, 6.7-7.7, and 7.8-11.0 mmol/L, we grouped fasting/postprandial glucose into five categories (<5.0/<6.7, <5.0/6.7-7.7, 5.0-5.5/<6.7, 5.0-5.5/6.7-7.7 mmol/L, 5.6-6.9/7.8-11.0 mmol/L). The primary outcome was incident diabetes. RESULTS In individuals with prediabetes, the presence of a baseline fasting glucose <5.0 mmol/L or a postprandial glucose <6.7 mmol/L led to a greater risk reduction of incident diabetes with hazard ratios of 0.34 (95% confidence interval, 0.27-0.42) and 0.47 (0.41-0.54), respectively, relative to a fasting glucose 5.6-6.9 mmol/L and a postprandial glucose 7.8-11.0 mmol/L. For individuals with prediabetes having fasting/postprandial glucose <5.0/<6.7 mmol/L, the incidence of 6.4 (4.7-8.8) per 1000 person-years corresponded to that of 5.8 (4.2-8.0) per 1000 person-years for individuals with normoglycemia having 5.0-5.5/6.7-7.7 mmol/L. CONCLUSIONS/INTERPRETATION Given that lower-than-normal glycemic levels were plausible for optimal risk reduction of diabetes, stringent glycemic management could be beneficial for diabetes prevention among individuals with prediabetes.
Collapse
Affiliation(s)
- Hung-Ju Lin
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Jui Wang
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Po-Yuan Tseng
- All Vista Healthcare Center, Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taiwan.
| | - Li-Chen Fu
- Department of Electrical Engineering, Department of Computer Science and Information Engineering, and Center for Artificial Intelligence & Advanced Robotics, National Taiwan University, Taipei, Taiwan.
| | - Yi-Chia Lee
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Integrative Medical Database Center, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan..
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Wei-Shiung Yang
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Integrative Medical Database Center, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Han-Mo Chiu
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
49
|
Li B, Zhou X, Wang W, Gao Z, Yan L, Qin G, Tang X, Wan Q, Chen L, Luo Z, Ning G, Mu Y. Remnant cholesterol is independently associated with diabetes, even if the traditional lipid is at the appropriate level: A report from the REACTION study. J Diabetes 2023; 15:204-214. [PMID: 36740459 PMCID: PMC10036259 DOI: 10.1111/1753-0407.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/09/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The association between remnant cholesterol (RC) and diabetes remains unclear because of limited study and data. This study attempted to explore the association between RC and diabetes in a large sample, multicenter general population. METHODS The current study included 36 684 participants from eight provinces across China. Subjects were quartered according to the RC quartile. Logistic regression analysis was used to evaluate the association between RC and diabetes. RESULTS After adjusting for potential confounding factors, RC was still significantly associated with diabetes (Q4: odds ratio [OR]:1.147, 95% confidence interval [CI]: 1.049-1.254, p = .003). In addition, RC and diabetes were still significantly associated when triglycerides (TG) were <1.7 mmol/L (Q4: OR: 1.155, 95% CI: 1.005-1.327, p = .042), low-density lipoprotein cholesterol (LDL-C) <3.4 mmol/L (Q4: OR: 1.130, 95% CI: 1.011-1.264, p = .032), or HDL-C (high-density lipoprotein cholesterol) ≥1.0 mmol/L (Q4: OR: 1.116, 95% CI: 1.007-1.237, p = .037). In the stratification analysis, elevated RC was significantly associated with diabetes in subjects with systolic blood pressure (SBP) <140 mm Hg and diastolic blood pressure (DBP) <90 mm Hg, 60 ≤ estimated glomerular filtration rate (eGFR) ≤90 ml/min per 1.73 m2 , younger than 55 years old and female. CONCLUSION In the Chinese community, RC is significantly correlated with diabetes, even when TG, LDL-C, or HDL-C were controlled within the appropriate range recommended by the guidelines.
Collapse
Affiliation(s)
- Binqi Li
- School of MedicineNankai UniversityTianjinChina
- Department of EndocrinologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xin Zhou
- Graduate SchoolChinese PLA General HospitalBeijingChina
- Department of Medical OncologyThe Fifth Medical Center of Chinese PLA General HospitalBeijingChina
- The Second Medical Center of Chinese PLA General HospitalBeijingChina
| | - Weiqing Wang
- Department of EndocrinologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhengnan Gao
- Department of EndocrinologyDalian Central HospitalDalianChina
| | - Li Yan
- Department of EndocrinologyZhongshan University Sun Yat‐sen Memorial HospitalGuangzhouChina
| | - Guijun Qin
- First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xulei Tang
- Department of EndocrinologyFirst Hospital of Lanzhou UniversityLanzhouChina
| | - Qin Wan
- Department of EndocrinologySouthwest Medical University Affiliated HospitalLuzhouChina
| | - Lulu Chen
- Wuhan Union Hospital, Huazhong University of Science and TechnologyWuhanChina
| | - Zuojie Luo
- First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Guang Ning
- Department of EndocrinologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yiming Mu
- School of MedicineNankai UniversityTianjinChina
- Department of EndocrinologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
- Graduate SchoolChinese PLA General HospitalBeijingChina
| |
Collapse
|
50
|
Type 2 Diabetes Prevention Programs-From Proof-of-Concept Trials to National Intervention and Beyond. J Clin Med 2023; 12:jcm12051876. [PMID: 36902668 PMCID: PMC10003211 DOI: 10.3390/jcm12051876] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
The prevention of type 2 diabetes (T2D) in high-risk people with lifestyle interventions has been demonstrated by several randomized controlled trials. The intervention effect has sustained up to 20 years in post-trial monitoring of T2D incidence. In 2000, Finland launched the national T2D prevention plan. For screening for high T2D risk, the non-laboratory Finnish Diabetes Risk Score was developed and widely used, also in other countries. The incidence of drug-treated T2D has decreased steadily since 2010. The US congress authorized public funding for a national diabetes prevention program (NDPP) in 2010. It was built around a 16-visit program that relies on referral from primary care and self-referral of persons with either prediabetes or by a diabetes risk test. The program uses a train-the-trainer program. In 2015 the program started the inclusion of online programs. There has been limited implementation of nationwide T2D prevention programs in other countries. Despite the convincing results from RCTs in China and India, no translation to the national level was introduced there. T2D prevention efforts in low-and middle-income countries are still limited, but results have been promising. Barriers to efficient interventions are greater in these countries than in high-income countries, where many barriers also exist. Health disparities by socioeconomic status exist for T2D and its risk factors and form a challenge for preventive interventions. It seems that a stronger commitment to T2D prevention is needed, such as the successful WHO Framework Convention on Tobacco Control, which legally binds the countries to act.
Collapse
|