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Yang CD, Aihemaiti M, Quan JW, Chen JW, Shu XY, Ding FH, Shen WF, Lu L, Zhang RY, Pan WQ, Wang XQ. HbA1c level is associated with the development of heart failure with recovered ejection fraction in hospitalized heart failure patients with type 2 diabetes. Int J Cardiol 2023; 371:259-265. [PMID: 36116615 DOI: 10.1016/j.ijcard.2022.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/26/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to advances in medical treatments, a substantial proportion of heart failure (HF) patients with reduced left ventricular ejection fraction (EF, HFrEF) have experienced partial or complete recovery of EF, termed HFrecEF, and markedly improved clinical outcomes. In the present study, we sought to investigate the relationship between glycemic control and the incidence of HFrecEF in hospitalized HFrEF patients with type 2 diabetes mellitus (T2DM). METHODS A total of 463 hospitalized T2DM patients with HFrEF were consecutively enrolled. Follow-up echocardiogram was performed after around 12 months. Patients who had an absolute EF improvement ≥10% and a second EF > 40% were classified into HFrecEF, and those who did not meet these criteria were defined as persistent HFrEF. RESULTS During the 12-month follow-up, 44.5% of T2DM patients developed HFrecEF. Patients with HFrecEF had significantly lower HbA1c level than those with persistent HFrEF (6.5% [IQR 5.8% ∼ 7.2%] vs. 6.7% [IQR 6.1% ∼ 7.8%], P = 0.003), especially in HF of an ischemic etiology. HbA1c levels were inversely correlated with changes in EF during follow-up. After multivariate adjustment, every 1% increase in HbA1c conferred a 17.4% (OR: 0.826 [95% CI 0.701-0.968]) lower likelihood of HFrecEF. Compared to patients with good glycemic control (HbA1c ≤ 6.2%), those with poor glycemic control (HbA1c > 7.1%) had a 52.0% (OR: 0.480 [95% CI 0.281-0.811] decreased likelihood of HFrecEF. CONCLUSIONS This study demonstrates that uncontrolled HbA1c level is associated with compromised development of HFrecEF in T2DM patients with HF, especially in those with an ischemic etiology.
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Affiliation(s)
- Chen Die Yang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China
| | - Muladili Aihemaiti
- Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China
| | - Jin Wei Quan
- Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China
| | - Jia Wei Chen
- Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China
| | - Xin Yi Shu
- Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China
| | - Feng Hua Ding
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China
| | - Wei Feng Shen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China; Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China
| | - Lin Lu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China; Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China
| | - Rui Yan Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China
| | - Wen Qi Pan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China.
| | - Xiao Qun Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China; Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, PR China.
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Chen S, Li L, Wu Z, Liu Y, Li F, Huang K, Wang Y, Chen Q, Wang X, Shen W, Zhang R, Shen Y, Lu L, Ding F, Dai Y. SerpinG1: A Novel Biomarker Associated With Poor Coronary Collateral in Patients With Stable Coronary Disease and Chronic Total Occlusion. J Am Heart Assoc 2022; 11:e027614. [PMID: 36515245 PMCID: PMC9798810 DOI: 10.1161/jaha.122.027614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background This study aimed to explore predictive biomarkers of coronary collateralization in patients with chronic total occlusion. Methods and Results By using a microarray expression profiling program downloaded from the Gene Expression Omnibus database, weighted gene coexpression network analysis was constructed to analyze the relationship between potential modules and coronary collateralization and screen out the hub genes. Then, the hub gene was identified and validated in an independent cohort of patients (including 299 patients with good arteriogenic responders and 223 patients with poor arteriogenic responders). Weighted gene coexpression network analysis showed that SERPING1 in the light-cyan module was the only gene that was highly correlated with both the gene module and the clinical traits. Serum levels of serpinG1 were significantly higher in patients with bad arteriogenic responders than in patients with good arteriogenic responders (472.53±197.16 versus 314.80±208.92 μg/mL; P<0.001) and were negatively associated with the Rentrop score (Spearman r=-0.50; P<0.001). Receiver operating characteristic curve analysis indicated that the area under the curve was 0.77 (95% CI, 0.72-0.81; P<0.001) for serum serpinG1 in prediction of bad arteriogenic responders. After adjusting for traditional cardiovascular risk factors, serum serpinG1 levels (per SD) remained an independent risk factor for bad arteriogenic responders (odds ratio, 2.20 [95% CI, 1.76-2.74]; P<0.001). Conclusions Our findings illustrate that SERPING1 screened by weighted gene coexpression network analysis was associated with poor collateralization in patients with chronic total occlusion.
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Affiliation(s)
- Shuai Chen
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Le‐Ying Li
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Zhi‐Ming Wu
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yong Liu
- Department of Nursing, Chongqing Medical and Pharmaceutical CollegeChongqingChina
| | - Fei‐Fei Li
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Ke Huang
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yi‐Xuan Wang
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Qiu‐Jing Chen
- Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Xiao‐Qun Wang
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Wei‐Feng Shen
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Rui‐Yan Zhang
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Shanghai Clinical Research Center for Interventional MedicineShanghaiChina
| | - Ying Shen
- Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Lin Lu
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
| | - Feng‐Hua Ding
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Shanghai Clinical Research Center for Interventional MedicineShanghaiChina
| | - Yang Dai
- Department of Vascular and Cardiology, Rui Jin HospitalShanghai Jiaotong University School of MedicineShanghaiChina,Institute of Cardiovascular DiseasesShanghai Jiaotong University School of MedicineShanghaiChina
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Lin XL, Li QY, Zhao DH, Liu JH, Fan Q. Serum glycated albumin is associated with in-stent restenosis in patients with acute coronary syndrome after percutaneous coronary intervention with drug-eluting stents: An observational study. Front Cardiovasc Med 2022; 9:943185. [PMID: 36237913 PMCID: PMC9551162 DOI: 10.3389/fcvm.2022.943185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background Previous studies have confirmed the predicted value of serum glycated albumin (GA) in atherosclerotic cardiovascular disease. However, the relationship between GA and the development of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation has not been verified in patients with acute coronary syndrome (ACS). Materials and methods In this study, 797 patients diagnosed with ACS who underwent re-coronary angiography more than 6 months after the first successful DES-based percutaneous coronary intervention (PCI) were eventually included. Patients were categorized into two groups based on the median GA levels of 14.94%. Moreover, multivariate logistic regression analysis models and the net reclassification improvement and integrated differentiation improvement risk models were constructed to assess the relationship between the GA and DES-ISR in patients with ACS. Results The GA was significantly associated with an increased risk of DES-ISR, upon adjusting for confounding factors (as nominal variate: OR 1.868, 95% CI 1.191-2.932, P = 0.007; as continuous variate: OR 1.109, 95% CI 1.040-1.183, P = 0.002). The addition of GA to a baseline risk model had an incremental effect on the predictive value for DES-ISR (AUC: GA vs. baseline model, 0.714 vs. 0.692, comparison P = 0.017; category-free net reclassification improvement (NRI) 0.080, P = 0.035; integrated discrimination improvement (IDI) 0.023, P < 0.001). Conclusion GA level was significantly associated with a high risk of DES-ISR in patients with ACS treated with PCI. Moreover, the addition of the GA to a baseline risk model has an incremental effect on the predictive potential for DES-ISR.
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Affiliation(s)
| | | | | | | | - Qian Fan
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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Liu C, Zhao Q, Ma X, Cheng Y, Sun Y, Zhang D, Liu X, Zhou Y. Prognostic implication of serum glycated albumin for patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. Cardiovasc Diabetol 2022; 21:11. [PMID: 35045846 PMCID: PMC8772172 DOI: 10.1186/s12933-022-01446-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/28/2021] [Indexed: 02/06/2023] Open
Abstract
Background It has been demonstrated that glycated albumin (GA) is significantly associated with diabetes complications and mortality. However, among patients diagnosed with non-ST-elevation acute coronary syndrome (NSTE-ACS) administered percutaneous coronary intervention (PCI), the predictive value of GA for poor prognosis is unclear. Methods This study eventually included 2247 NSTE-ACS patients in Beijing Anzhen Hospital, Capital Medical University in January-December 2015 who received PCI. All patients were followed up until death or for 48 months post-discharge. The primary endpoint was major adverse cardio-cerebral events (MACCEs), including all-cause death, non-fatal myocardial infarction, ischemia-induced revascularization and non-fatal ischemic stroke. Results In total, 547 (24.3%) MACCEs were recorded during the follow-up period. Upon adjusting for potential confounders, GA remained an important risk predictor of MACCEs (As nominal variate: hazard ratio [HR] 1.527, 95% confidence interval [CI] 1.236–1.886, P < 0.001; As continuous variate: HR 1.053, 95% CI 1.027–1.079, P < 0.001). GA addition significantly enhanced the predictive ability of the traditional risk model (Harrell’s C-index, GA vs. Baseline model, 0.694 vs. 0.684, comparison P = 0.002; continuous net reclassification improvement (continuous-NRI) 0.085, P = 0.053; integrated discrimination improvement (IDI) 0.007, P = 0.020). Conclusion GA is highly correlated with poor prognosis in NSTE-ACS patients undergoing PCI, suggesting that it may be a major predictive factor of adverse events among these individuals. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01446-3.
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5
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Pei J, Wang X, Xing Z. Traditional Cardiovascular Risk Factors and Coronary Collateral Circulation: A Meta-Analysis. Front Cardiovasc Med 2021; 8:743234. [PMID: 34805302 PMCID: PMC8595282 DOI: 10.3389/fcvm.2021.743234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Patients with well-developed coronary collateral circulation (CC) usually have low mortality, improved cardiac function, and reduced infarct size. Currently, there is conflicting evidence on the association between traditional cardiovascular risk factors (diabetes, hypertension, and smoking habit) and CC. Design: We performed a meta-analysis of case-control studies to better understand such associations. Data Sources: We searched the MEDINE, EMBASE, and Science Citation Index databases to identify relevant studies. Eligibility Criteria for Selecting Studies: Case control studies reporting data on risk factors (smoking habit, hypertension, and diabetes mellites) in comparing cases between poor CC and well-developed CC groups. Well-developed CC was the primary outcome of this meta-analysis Data Extraction and Synthesis: Relevant data were extracted by two independent investigators. We derived pooled odds ratios (ORs) with random effects models. We performed quality assessments, publication bias, and sensitivity analysis to ensure the reliability of our results. Results: In total, 18 studies that had 4,746 enrolled patients were analyzed. Our results showed that hypertension and smoking habit did not (OR = 0.94, 95% CI: 0.75–1.17, p = 0.564 and OR = 1.00, 95% CI: 0.84–1.18, p = 0.970, respectively), and diabetes did (OR = 0.50, 95% CI: 0.38–0.67, p = 0.00001) affect the development of CC. Conclusion: Unlike hypertension and smoking habit, diabetes was associated with poor CC formation. Trial Registration Number:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=87821, identifier: CRD42018087821.
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Affiliation(s)
- Junyu Pei
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaopu Wang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China.,Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha, China
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6
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Association between the triglyceride glucose index and coronary collateralization in coronary artery disease patients with chronic total occlusion lesions. Lipids Health Dis 2021; 20:140. [PMID: 34689767 PMCID: PMC8543811 DOI: 10.1186/s12944-021-01574-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/05/2021] [Indexed: 01/18/2023] Open
Abstract
Background Recent studies have substantiated the role of the triglyceride glucose (TyG) index in predicting the prognosis of coronary artery disease (CAD) patients, while no relevant studies have revealed the association between the TyG index and coronary collateralization in the event of coronary chronic total occlusion (CTO). The current study intends to explore whether, or to what extent, the TyG index is associated with impaired collateralization in CAD patients with CTO lesions. Methods The study enrolled 1093 CAD patients undergoing cardiac catheterization for at least one CTO lesion. Data were collected from the Beijing Anzhen Hospital record system. The degree of collaterals was determined according to the Rentrop classification system. The correlation between the TyG index and coronary collateralization was assessed. Results Overall, 318 patients were included in a less developed collateralization (Rentrop classification 0-1) group. The TyG index was significantly higher in patients with impaired collateralization (9.3±0.65 vs. 8.8±0.53, P<0.001). After adjusting for various confounding factors, the TyG index remained correlated with the occurrence of impaired collateralization, with odds ratios (ORs) of 1.59 and 5.72 in the T2 and T3 group compared with the first tertile group (P<0.001). In addition, subgroup analysis showed that higher TyG index values remained strongly associated with increased risk of less developed collateralization. To compare the risk assessment efficacy for the formation of collateralization between the TyG index and other metabolic abnormality indicators, an area under the receiver-operating characteristic (ROC) curve (AUC) was obtained. A significant improvement in the risk assessment performance for impaired collateralization emerged when adding the TyG index into a baseline model. Conclusions The increased TyG index is strongly associated with less developed collateralization in CAD patients with CTO lesions and its risk assessment performance is better than single metabolic abnormality indicators. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-021-01574-x.
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7
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Zhang L, Zhang J, Han B, Chen C, Liu J, Sun Z, Liu M, Zhou P. Gestational Diabetes Mellitus-Induced Changes in Proteomes and Glycated/Glycosylated Proteomes of Human Colostrum. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:10749-10759. [PMID: 34474557 DOI: 10.1021/acs.jafc.1c03791] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Gestational diabetes mellitus (GDM) not only has a bad effect on the development of infants but also causes variations in breastmilk composition. This study aims to investigate the changes in the protein profile of colostrum between mothers with GDM and healthy mothers (H) by sequential windowed acquisition of all theoretical fragment ion proteomics techniques. A total of 1295 proteins were detected, with 192 proteins being significantly different between GDM and H. These significantly different proteins were enriched with the carbohydrate and lipid metabolism pathway as well as immunity. Some proteins had an AOC value of 1, such as apolipoprotein E and lipoprotein lipase. In addition, we identified 42 glycated and 93 glycosylated peptides in colostrum without any enrichment, with glycated peptides being upregulated and glycosylated peptides being downregulated in colostrum with GDM. These results help us to better understand the GDM-induced changes in proteomes and glycated and glycosylated level and provide guidance on infant formula adjustment for infants from mothers with GDM.
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Affiliation(s)
- Lina Zhang
- State Key Laboratory of Food Science & Technology, Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Jinyue Zhang
- State Key Laboratory of Food Science & Technology, Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Binsong Han
- State Key Laboratory of Food Science & Technology, Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | | | - Jun Liu
- The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, Jiangsu Province 214002, China
| | - Zhaona Sun
- The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, Jiangsu Province 214002, China
| | - Min Liu
- The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, Jiangsu Province 214002, China
| | - Peng Zhou
- State Key Laboratory of Food Science & Technology, Jiangnan University, Wuxi, Jiangsu Province 214122, China
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8
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Razzouk L, Jneid H. Revascularization in patients with diabetes and chronic total occlusion: The journey or the destination? Catheter Cardiovasc Interv 2021; 97:384-385. [PMID: 33729678 DOI: 10.1002/ccd.29532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Louai Razzouk
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Hani Jneid
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Zhang J, Du Y, Hu C, Liu Y, Liu J, Gao A, Zhao Y, Zhou Y. Elevated Glycated Albumin in Serum Is Associated with Adverse Cardiac Outcomes in Patients with Acute Coronary Syndrome Who Underwent Revascularization Therapy. J Atheroscler Thromb 2021; 29:482-491. [PMID: 33642440 PMCID: PMC9090483 DOI: 10.5551/jat.61358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims:
The associations between increased glycated albumin (GA) in the serum and diabetic complications and mortality have been revealed in the general population. However, less is known regarding the prognostic value of GA in patients diagnosed with acute coronary syndrome (ACS).
Methods:
In this study, all patients admitted for ACS who underwent a successful percutaneous coronary intervention (PCI) at our center from January 2018 to February 2019 were retrospectively examined. Clinical characteristics, laboratory results (e.g., serum GA levels), and procedural details were collected. The primary outcome included a composite of major adverse cardio-cerebral events (MACCE), such as death, myocardial infarction, stroke, and unplanned revascularization. The association between serum GA levels and clinical outcomes was tested in three multivariable models using Cox proportional hazard analysis. Subgroup analysis was performed in patients who were diagnosed with diabetes versus patients without diabetes.
Results:
A total of 1,806 ACS patients (mean age of 59.4 years; 77.8% were men; 44.9% were diagnosed with diabetes) were enrolled in this study, where the majority exhibited unstable angina (81.6%) and showed preserved left ventricular systolic function. Patients in the high GA level group were commonly female and were more likely to have metabolic disorders and to exhibit severe CAD (all
p
<0.05). MACCE occurred in 126 patients (7.0%) during a mean follow-up time of 17.2 months. The cumulative risk of MACCE at the 18-month follow-up visit significantly increased in a stepwise fashion along with increased GA levels (log-rank
p
=0.018) in the serum. The association between serum GA levels and MACCE was further determined after adjusting traditional risk factors and hemoglobin A1c (HbA1c) (GA, per 1% increase: hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.06–1.13; GA, higher vs. lower tertial: HR 1.92, 95% CI 1.01–3.67). In a subgroup analysis, the prognostic role of serum GA only existed in diabetic patients, even when adjusting for traditional risk factors and HbA1c levels.
Conclusions:
Elevated GA levels in the serum were associated with poor intermediate-term outcomes in low-risk ACS patients who underwent PCI, especially in patients with preexisting diabetes.
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Affiliation(s)
- Jianwei Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University
| | - Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University
| | - Chengping Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University
| | - Yan Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University
| | - Jinxing Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University
| | - Ang Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University
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Chen Z, Zhang J, Feng J, Zhou G, Jin X, Pan J. Higher serum level of Cystatin C: An additional risk factor of CAD. Medicine (Baltimore) 2021; 100:e24269. [PMID: 33466214 PMCID: PMC7808466 DOI: 10.1097/md.0000000000024269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Cystatin C has been proposed as a useful biomarker of early impaired kidney function and a predictor of mortality risk. The present study is to investigate the association between serum Cystatin C and the severity of coronary artery lesions, Gensini score (GS), and the risk of coronary artery disease (CAD).A total of 682 CAD patients (230 females, 452 males; mean age 62.6 ± 10.7 years, range from 31 to 86 years) and 135 controls (41 females, 94 males; mean age 58.0 ± 10.3 years, range from 38 to 84 years) were recruited in the present study. Enzyme-linked immunosorbent assay was applied to measure serum cystatin C levels and other serum indexes. The estimated glomerular filtration rate and GS were calculated.Serum low-density lipoprotein cholesterol (LDL-C), uric acid, Cystatin C, and homocysteine (HCY) were significantly elevated in CAD patients compared to controls. There were significant differences regarding total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, cystatin C, eGFR and GS among stable angina pectoris (SAP), unstable angina group (UAP), and acute myocardial infarction (AMI) patients. AMI group had an elevated serum Cystatin C, LDL-C, HCY, and GS than SAP and UAP patients. When stratified patient groups by the quartiles of Cystatin C, we found age, the proportion of male and patients with diabetes, HCY, and GS were increased in Q4 than in other quartile groups. Spearman correlation test revealed a positive relationship between Cystatin C, HCY, and GS. Multivariate logistic regression analysis revealed that serum Cystatin C level, presence of hypertension and diabetes, HCY, age, and male were the risk factors for coronary artery lesions.In summary, our results suggested that cystatin C is a promising clinical biomarker that provides complementary information to the established risk determinants. The serum Cystatin C level is strongly associated with GS and could be used to evaluate the severity of coronary artery lesions.
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Affiliation(s)
- Zhenfei Chen
- Department of Cardiology, The Second Hospital of Hefei City, Hefei, Anhui, China
| | - Jing Zhang
- Department of Cardiology, The Second Hospital of Hefei City, Hefei, Anhui, China
| | - Jun Feng
- Department of Cardiology, The Second Hospital of Hefei City, Hefei, Anhui, China
| | - Gaoliang Zhou
- Department of Cardiology, The Second Hospital of Hefei City, Hefei, Anhui, China
| | - Xiaoqin Jin
- Department of Cardiology, The Second Hospital of Hefei City, Hefei, Anhui, China
| | - Jianyuan Pan
- Department of Cardiology, The Second Hospital of Hefei City, Hefei, Anhui, China
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg University, Germany
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Yang ZK, Shen Y, Dai Y, Wang XQ, Hu J, Ding FH, Zhang RY, Lu L, Shen WF. Impact of coronary collateralization on long-term clinical outcomes in type 2 diabetic patients after successful recanalization of chronic total occlusion. Cardiovasc Diabetol 2020; 19:59. [PMID: 32393276 PMCID: PMC7216347 DOI: 10.1186/s12933-020-01033-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
Background To assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Methods Coronary collateralization was graded according to Rentrop scoring system in 198 type 2 diabetic patients and 335 non-diabetics with stable angina undergoing PCI for at least one CTO lesion. Left ventricular ejection fraction (LVEF) was determined and major adverse cardio-cerebral events (MACCE) were recorded during follow-up. Results Poor collateralization was more common in patients with T2DM than in non-diabetics (40% vs 29%, p = 0.008). At 13.5 ± 4.1 months, the rate of composite MACCE (17.3% vs 27.6%, p = 0.034) and repeat revascularization (15.2% vs 25.5%, p = 0.026) was lower and the increase in LVEF (3.10% vs 1.80%, p = 0.024) was greater in patients with good collaterals than in those with poor collaterals for non-diabetic group. The associations were in the same direction for T2DM group (35% vs 44%; 30% vs 36%; 2.14% vs 1.65%, respectively) with a higher all-cause mortality in diabetic patients with poor collaterals (p = 0.034). Multivariable Cox proportional hazards analysis showed that coronary collateralization was an independent factor for time to MACCE (HR 2.155,95% CI 1.290–3.599, p = 0.003) and repeat revascularization (HR 2.326, 95% CI 1.357–3.986, p = 0.002) in non-diabetic patients, but did not enter the model in those with T2DM. Conclusions T2DM is associated with reduced coronary collateralization. The effects of the status of coronary collateralization on long-term clinical outcomes and left ventricular function appear to be similar in size in type 2 diabetic patients and non-diabetics after successful recanalization of CTO.
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Affiliation(s)
- Zhen Kun Yang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Yang Dai
- Institute of Cardiovascular Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Jian Hu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Cardiovascular Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China.
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Shen Y, Dai Y, Wang XQ, Zhang RY, Lu L, Ding FH, Shen WF. Searching for optimal blood pressure targets in type 2 diabetic patients with coronary artery disease. Cardiovasc Diabetol 2019; 18:160. [PMID: 31733658 PMCID: PMC6858977 DOI: 10.1186/s12933-019-0959-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Controversies exist regarding the optimal blood pressure (BP) level that is safe and provides cardiovascular protection in patients with type 2 diabetes mellitus (T2DM) and coexistent coronary artery disease. Several new glucose-lowering agents have been found to lower BP as well, making the interaction between BP and T2DM even more complex. METHODS With the reference to recent literature, this review article describes the potential mechanisms of increased risk of hypertension in T2DM and outlines the possible optimal BP levels based upon recommendations on the management of hypertension by the current guidelines, in combination with our research findings, for type 2 diabetic patients with coronary artery disease. RESULTS The development of hypertension in T2DM involves multiple processes, including enhanced sympathetic output, inappropriate activation of renin-angiotensin- aldosterone system, endothelial dysfunction induced through insulin resistance, and abnormal sodium handling by the kidney. Both AGE-RAGE axis and adipokine dysregulation activate intracellular signaling pathways, increase oxidative stress, and aggravate vascular inflammation. Pancreatic β-cell specific microRNAs are implicated in gene expression and diabetic complications. Non-pharmacological intervention with lifestyle changes improves BP control, and anti-hypertensive medications with ACEI/ARB, calcium antagonists, β-blockers, diuretics and new hypoglycemic agent SGLT2 inhibitors are effective to decrease mortality and prevent major adverse cardiovascular events. For hypertensive patients with T2DM and stable coronary artery disease, control of BP < 130/80 mmHg but not < 120/70 mmHg is reasonable, whereas for those with chronic total occlusion or acute coronary syndromes, an ideal BP target may be somewhat higher (< 140/90 mmHg). Caution is advised with aggressive lowering of diastolic BP to a critical threshold (< 60 mmHg). CONCLUSIONS Hypertension and T2DM share certain similar aspects of pathophysiology, and BP control should be individualized to minimize adverse events and maximize benefits especially for patients with T2DM and coronary artery disease.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Yang Dai
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
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Fadini GP, Albiero M, Bonora BM, Avogaro A. Angiogenic Abnormalities in Diabetes Mellitus: Mechanistic and Clinical Aspects. J Clin Endocrinol Metab 2019; 104:5431-5444. [PMID: 31211371 DOI: 10.1210/jc.2019-00980] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Diabetes causes severe pathological changes to the microvasculature in many organs and tissues and is at the same time associated with an increased risk of coronary and peripheral macrovascular events. We herein review alterations in angiogenesis observed in human and experimental diabetes and how they contribute to diabetes onset and development of vascular complications. EVIDENCE ACQUISITION The English language medical literature was searched for articles reporting on angiogenesis/vasculogenesis abnormalities in diabetes and their clinical manifestations, mechanistic aspects, and possible therapeutic implications. EVIDENCE SYNTHESIS Angiogenesis is a complex process, driven by a multiplicity of molecular mechanisms and involved in several physiological and pathological conditions. Incompetent angiogenesis is pervasive in diabetic vascular complications, with both excessive and defective angiogenesis observed in various tissues. A striking different angiogenic response typically occurs in the retina vs the myocardium and peripheral circulation, but some commonalities in abnormal angiogenesis can explain the well-known association between microangiopathy and macroangiopathy. Impaired angiogenesis can also affect endocrine islet and adipose tissue function, providing a link to diabetes onset. Exposure to high glucose itself directly affects angiogenic/vasculogenic processes, and the mechanisms include defective responses to hypoxia and proangiogenic factors, impaired nitric oxide bioavailability, shortage of proangiogenic cells, and loss of pericytes. CONCLUSIONS Dissecting the molecular drivers of tissue-specific alterations of angiogenesis/vasculogenesis is an important challenge to devise new therapeutic approaches. Angiogenesis-modulating therapies should be carefully evaluated in view of their potential off-target effects. At present, glycemic control remains the most reasonable therapeutic strategy to normalize angiogenesis in diabetes.
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Affiliation(s)
- Gian Paolo Fadini
- Department of Medicine, University of Padova, Padova, Italy
- Venetian Institute of Molecular Medicine, Padova, Italy
| | - Mattia Albiero
- Department of Medicine, University of Padova, Padova, Italy
- Venetian Institute of Molecular Medicine, Padova, Italy
| | - Benedetta Maria Bonora
- Department of Medicine, University of Padova, Padova, Italy
- Venetian Institute of Molecular Medicine, Padova, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
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Shen Y, Chen S, Dai Y, Wang XQ, Zhang RY, Yang ZK, Hu J, Lu L, Ding FH, Shen WF. Lipoprotein (a) interactions with cholesterol-containing lipids on angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol 2019; 18:82. [PMID: 31234867 PMCID: PMC6589890 DOI: 10.1186/s12933-019-0888-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background We investigated whether or to what extent the interaction of lipoprotein (a) [Lp(a)] with cholesterol-containing lipids was associated with angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion. Methods Serum levels of Lp(a), total cholesterol, low-density lipoprotein–cholesterol (LDL-C), high-density lipoprotein–cholesterol (HDL-C), and triglyceride were determined and non-HDL-C was calculated in 706 type 2 diabetic and 578 non-diabetic patients with stable coronary artery disease and angiographic total occlusion of at least one major coronary artery. The degree of collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded as poor (Rentrop score of 0 or 1) or good coronary collateralization (Rentrop score of 2 or 3). Results For diabetic and non-diabetic patients, Lp(a), total cholesterol, LDL-C, and non-HDL-C levels were higher in patients with poor coronary collateralization than in those with good collateralization, whereas HDL-C and triglyceride levels were similar. After adjustment for potential confounding factors, tertiles of Lp(a), total cholesterol, LDL-C and non-HDL-C remained independent determinants for poor collateralization. A significant interaction between Lp(a) and total cholesterol, LDL-C or non-HDL-C was observed in diabetic patients (all P interaction < 0.001) but not in non-diabetics. At high tertile of total cholesterol (≥ 5.35 mmol/L), LDL-C (≥ 3.36 mmol/L) and non-HDL-C (≥ 4.38 mmol/L), diabetic patients with high tertile of Lp(a) (≥ 30.23 mg/dL) had an increased risk of poor collateralization compared with those with low tertile of Lp(a) (< 12.66 mg/dL) (adjusted OR = 4.300, 3.970 and 4.386, respectively, all P < 0.001). Conclusions Increased Lp(a) confers greater risk for poor coronary collateralization when total cholesterol, LDL-C or non-HDL-C are elevated especially for patients with type 2 diabetes. Electronic supplementary material The online version of this article (10.1186/s12933-019-0888-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Shuai Chen
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Yang Dai
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Zhen Kun Yang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Jian Hu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
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15
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Regulation of Metabolic Disease-Associated Inflammation by Nutrient Sensors. Mediators Inflamm 2018; 2018:8261432. [PMID: 30116154 PMCID: PMC6079375 DOI: 10.1155/2018/8261432] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/21/2018] [Accepted: 06/14/2018] [Indexed: 12/15/2022] Open
Abstract
Visceral obesity is frequently associated with the development of type 2 diabetes (T2D), a highly prevalent chronic disease that features insulin resistance and pancreatic β-cell dysfunction as important hallmarks. Recent evidence indicates that the chronic, low-grade inflammation commonly associated with visceral obesity plays a major role connecting the excessive visceral fat deposition with the development of insulin resistance and pancreatic β-cell dysfunction. Herein, we review the mechanisms by which nutrients modulate obesity-associated inflammation.
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16
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Shen Y, Yang ZK, Hu J, Wang XQ, Dai Y, Zhang S, Zhang RY, Lu L, Ding FH, Shen WF. Donor artery stenosis interactions with diastolic blood pressure on coronary collateral flow in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol 2018; 17:76. [PMID: 29859086 PMCID: PMC5984405 DOI: 10.1186/s12933-018-0724-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/26/2018] [Indexed: 12/12/2022] Open
Abstract
Background We investigated whether and to what extent stenosis of predominant collateral donor artery (PCDA) affects coronary collateral flow in relation to blood pressure (BP) in type 2 diabetic patients with chronic total occlusion (CTO). Methods Collateral flow index (CFI) as derived from intracoronary pressure distal to occluded segment and mean aortic pressure in 220 type 2 diabetic patients and 220 propensity score matched non-diabetic controls undergoing percutaneous coronary intervention for CTO. The severity of PCDA stenosis was graded according to lumen diameter narrowing. Results CFI decreased stepwise from mild to severe stenosis of the PCDA and was lower in diabetic patients with moderate or severe PCDA stenosis than in non-diabetic controls (0.36 ± 0.10 vs. 0.45 ± 0.08, P < 0.001; 0.29 ± 0.09 vs. 0.35 ± 0.08, P = 0.008). When the PCDA was mildly stenotic, CFI increased initially along with a reduction in diastolic BP, and decreased when diastolic BP was below 60 mmHg in diabetic patients (0.38 ± 0.16 vs. 0.57 ± 0.09, P < 0.001). In the presence of moderate PCDA stenosis, diabetic patients had significantly lower CFI compared to non-diabetic controls, with a relative reduction of 19.8% at diastolic BP 70–79 mmHg, 28.2% at 60–69 mmHg and 38.2% below 60 mmHg (all P < 0.05). A severe PCDA stenosis resulted in a more pronounced decrease in CFI, with a relative reduction of 37.3% for diabetics compared to non-diabetics when diastolic BP was below 60 mmHg (P = 0.050). Conclusions In the setting of CTO, donor artery stenosis confers greater risk for reduced coronary collateral flow when diastolic BP is decreased. Even a moderate stenosis in the PCDA may be associated with lower collateral flow as diastolic BP decreases below 80 mmHg in type 2 diabetic than in non-diabetic patients.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Zhen Kun Yang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Jian Hu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Yang Dai
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Su Zhang
- College of Biomedical Engineering, Jiao Tong University, Shanghai, 200031, People's Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.,Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
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17
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Shen Y, Ding FH, Dai Y, Wang XQ, Zhang RY, Lu L, Shen WF. Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol 2018; 17:26. [PMID: 29422093 PMCID: PMC5804044 DOI: 10.1186/s12933-018-0671-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The extent of coronary collateral formation is a primary determinant of the severity of myocardial damage and mortality after coronary artery occlusion. Type 2 diabetes mellitus (T2DM) represents an important risk factor for impaired collateral vessel growth. However, the mechanism of reduced coronary collateralization in type 2 diabetic patients remains unclear. METHODS With the reference to the recent researches, this review article describes the pathogenic effects of T2DM on collateral development and outlines possible clinical and biochemical markers associated with reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion (CTO). RESULTS Diffuse coronary atherosclerosis in T2DM reduces pressure gradient between collateral donor artery and collateral recipient one, limiting collateral vessel growth and function. An interaction between advanced glycation end-products and their receptor activates several intracellular signaling pathways, enhances oxidative stress and aggravates inflammatory process. Diabetic condition decreases pro-angiogenic factors especially vascular endothelial growth factor and other collateral vessel growth related parameters. Numerous clinical and biochemical factors that could possibly attenuate the development of coronary collaterals have been reported. Increased serum levels of glycated albumin, cystatin C, and adipokine C1q tumor necrosis factor related protein 1 were associated with poor coronary collateralization in type 2 diabetic patients with stable coronary artery disease and CTO. Diastolic blood pressure and stenosis severity of the predominant collateral donor artery also play a role in coronary collateral formation. CONCLUSIONS T2DM impairs collateral vessel growth through multiple mechanisms involving arteriogenesis and angiogenesis, and coronary collateral formation in patients with T2DM and CTO is influenced by various clinical, biochemical and angiographic factors. This information provides insights into the understanding of coronary pathophysiology and searching for potential new therapeutic targets in T2DM.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Yang Dai
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
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Fanaroff AC, James SK, Weisz G, Prather K, Anstrom KJ, Mark DB, Ben-Yehuda O, Alexander KP, Stone GW, Ohman EM. Ranolazine After Incomplete Percutaneous Coronary Revascularization in Patients With Versus Without Diabetes Mellitus: RIVER-PCI Trial. J Am Coll Cardiol 2017; 69:2304-2313. [PMID: 28473136 DOI: 10.1016/j.jacc.2017.02.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/27/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic angina is more common in patients with diabetes mellitus (DM) with poor glucose control. Ranolazine both treats chronic angina and improves glucose control. OBJECTIVES This study sought to examine ranolazine's antianginal effect in relation to glucose control. METHODS The authors performed a secondary analysis of the RIVER-PCI (Ranolazine in Patients with Incomplete Revascularization after Percutaneous Coronary Intervention) trial, a clinical trial in which 2,604 patients with chronic angina and incomplete revascularization following percutaneous coronary intervention were randomized to ranolazine versus placebo. Mixed-effects models were used to compare the effects of ranolazine versus placebo on glycosylated hemoglobin (HbA1c) at 6- and 12-month follow-up. Interaction between baseline HbA1c and ranolazine's effect on Seattle Angina Questionnaire angina frequency at 6 and 12 months was tested. RESULTS Overall, 961 patients (36.9%) had DM at baseline. Compared with placebo, ranolazine significantly decreased HbA1c by 0.42 ± 0.08% (adjusted mean difference ± SE) and 0.44 ± 0.08% from baseline to 6 and 12 months, respectively, in DM patients, and by 0.19 ± 0.02% and 0.20 ± 0.02% at 6 and 12 months, respectively, in non-DM patients. Compared with placebo, ranolazine significantly reduced Seattle Angina Questionnaire angina frequency at 6 months among DM patients but not at 12 months. The reductions in angina frequency were numerically greater among patients with baseline HbA1c ≥7.5% than those with HbA1c <7.5% (interaction p = 0.07). CONCLUSIONS In patients with DM and chronic angina with incomplete revascularization after percutaneous coronary intervention, ranolazine's effect on glucose control and angina at 6 months was proportionate to baseline HbA1c, but the effect on angina dissipated by 12 months.
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Affiliation(s)
- Alexander C Fanaroff
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Giora Weisz
- Division of Cardiology, Columbia University, New York, New York; Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Kristi Prather
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Daniel B Mark
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | | | - Karen P Alexander
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
| | - Gregg W Stone
- Division of Cardiology, Columbia University, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - E Magnus Ohman
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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Yazdanpanah S, Rabiee M, Tahriri M, Abdolrahim M, Rajab A, Jazayeri HE, Tayebi L. Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: A comprehensive review. Crit Rev Clin Lab Sci 2017; 54:219-232. [PMID: 28393586 DOI: 10.1080/10408363.2017.1299684] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Diabetes Mellitus (DM) is a group of metabolic diseases characterized by chronic high blood glucose concentrations (hyperglycemia). When it is left untreated or improperly managed, it can lead to acute complications including diabetic ketoacidosis and non-ketotic hyperosmolar coma. In addition, possible long-term complications include impotence, nerve damage, stroke, chronic kidney failure, cardiovascular disease, foot ulcers, and retinopathy. Historically, universal methods to measure glycemic control for the diagnosis of diabetes included fasting plasma glucose level (FPG), 2-h plasma glucose (2HP), and random plasma glucose. However, these measurements did not provide information about glycemic control over a long period of time. To address this problem, there has been a switch in the past decade to diagnosing diabetes and its severity through measurement of blood glycated proteins such as Hemoglobin A1c (HbA1c) and glycated albumin (GA). Diagnosis and evaluation of diabetes using glycated proteins has many advantages including high accuracy of glycemic control over a period of time. Currently, common laboratory methods used to measure glycated proteins are high-performance liquid chromatography (HPLC), immunoassay, and electrophoresis. HbA1c is one of the most important diagnostic factors for diabetes. However, some reports indicate that HbA1c is not a suitable marker to determine glycemic control in all diabetic patients. GA, which is not influenced by changes in the lifespan of erythrocytes, is thought to be a good alternative indicator of glycemic control in diabetic patients. Here, we review the literature that has investigated the suitability of HbA1c, GA and GA:HbA1c as indicators of long-term glycemic control and demonstrate the importance of selecting the appropriate glycated protein based on the patient's health status in order to provide useful and modern point-of-care monitoring and treatment.
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Affiliation(s)
- Sara Yazdanpanah
- a Biomaterials Group, Faculty of Biomedical Engineering , Amirkabir University of Technology , Tehran , Iran
| | - Mohammad Rabiee
- a Biomaterials Group, Faculty of Biomedical Engineering , Amirkabir University of Technology , Tehran , Iran
| | - Mohammadreza Tahriri
- a Biomaterials Group, Faculty of Biomedical Engineering , Amirkabir University of Technology , Tehran , Iran.,b Marquette University School of Dentistry , Milwaukee , WI , USA.,c Dental Biomaterials Department , School of Dentistry, Tehran University of Medical Sciences , Tehran , Iran
| | - Mojgan Abdolrahim
- a Biomaterials Group, Faculty of Biomedical Engineering , Amirkabir University of Technology , Tehran , Iran
| | | | | | - Lobat Tayebi
- b Marquette University School of Dentistry , Milwaukee , WI , USA
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Yang C, Zhu W, Han X, Ma A, Bai L, Xu F. Association of CXCR4 expression with coronary collateralization in patients with chronic total coronary occlusion: A nested case-control study. Int J Cardiol 2017; 228:501-506. [PMID: 27875725 DOI: 10.1016/j.ijcard.2016.11.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 11/05/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE CXCR4 signaling contributes to the development and progression of neovascularization. The objective of this study was to investigate whether CXCR4 expression in peripheral CD34+ cells associated with the coronary collateralization (CC) in patients with chronic total coronary occlusion (CTO). METHODS AND RESULTS We measured CXCR4 expression in peripheral CD34+ cells and assessed its relation with CC in a nested case-control study including 78 cases and 78 matched controls aged 38-69years, assessed in January 2011 to December 2012 and with at least 1year of follow-up before the index date. Cases were defined as good coronary collateralization (GCC) according to the Rentrop scoring system (Rentrop score of 2 or 3); for each case, one age-matched control with poor coronary collateralization (PCC) (Rentrop score 0 or 1) was randomly selected from the study participants. Demographic, biochemical, and angiographic variables were collected. In multivariate analysis, the OR (95% CI) of CXCR4 expression was 0.018 (0.017 to 0.020) in patients with GCC versus PCC. Independent effect of CXCR4 expression on CC was (OR 0.012, 95% CI 0.010-0.014) when adjusted for other variables. A nonlinear relationship between CXCR4 expression and CC was observed. The CC degree increased when CXCR4 expression exceeded the turning point (30%) (OR 0.025, 95% CI 0.022-0.028; p<0.001). When the CXCR4 expression exceeded 75%, increased CXCR4 level could not promoted CC (OR 0.000, 95% CI 0.008-0.007; p=0.974). CONCLUSION Increased CXCR4 level in peripheral CD34+ cells was associated with GCC in patients with CTO.
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Affiliation(s)
- Chun Yang
- Department of Cardiology, The First Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China.
| | - Wenjin Zhu
- Department of Cardiology, The First Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China
| | - Xiu Han
- Department of Cardiology, The First Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China
| | - Aiqun Ma
- Department of Cardiology, The First Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China
| | - Ling Bai
- Department of Cardiology, The First Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China
| | - Feng Xu
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, Shaanxi 710049, PR China
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Shen Y, Ding FH, Zhang RY, Zhang Q, Lu L, Shen WF. Data on the value of elevated circulating mimecan levels for detecting poor coronary collateralization in patients with stable angina and chronic total occlusion. Data Brief 2016; 9:585-588. [PMID: 27761514 PMCID: PMC5064991 DOI: 10.1016/j.dib.2016.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/05/2016] [Accepted: 09/19/2016] [Indexed: 12/03/2022] Open
Abstract
The data presented here support the research article “Association of serum mimecan with angiographic coronary collateralization in patients with stable coronary artery disease and chronic total occlusion” (Shen et al., 2016) [1] where elevated circulating mimecan levels reflected poor angiographic coronary collateralization in such patients. The data included in this article are composed by one figure and consist of (1) validation of serum mimecan measurement by assessing inter- and intra-assay variability in 45 samples; (2) findings on the relation of clinical and angiographic characteristics and biochemical parameters to coronary collateralization in 559 patients; (3) the diagnostic value of serum mimecan for poor collateralization, which was derived from plotting receiver-operating characteristic curves and logistic regression analysis.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People׳s Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People׳s Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People׳s Republic of China
| | - Qi Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People׳s Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People׳s Republic of China; Institute of Cardiovascular Diseases, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People׳s Republic of China
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People׳s Republic of China; Institute of Cardiovascular Diseases, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People׳s Republic of China
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Relation Between C-X-C Motif Chemokine Receptor 4 Levels and the Presence and Extent of Angiographic Coronary Collaterals in Patients With Chronic Total Coronary Occlusion. Am J Cardiol 2016; 118:1136-1143. [PMID: 27569386 DOI: 10.1016/j.amjcard.2016.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 01/07/2023]
Abstract
Coronary collateral circulation is an alternative source of blood supply to the myocardium in the presence of chronic total coronary occlusion (CTO). C-X-C motif chemokine receptor 4 (CXCR4) signaling usually contributes to neovascularization. Here, we investigate the relation between CXCR4 levels in peripheral blood CD34+ cells and the formation of angiographic coronary collaterals and determine the risk factors that affect CXCR4 expression in patients with CTO. Demographic, biochemical, and angiographic variables were collected from 324 patients with CTO and 90 negative controls. The presence and extent of collaterals were scored according to the Rentrop scoring system (Rentrop's). CXCR4 levels and plasma biochemical factors were detected. Clinical outcomes were collected during a 12-month follow-up. Results show that low (Rentrop's 0 or 1) and high (Rentrop's of 2 or 3) coronary collateralizations were detected in 183 and 141 patients, respectively. The Rentrop scores were positively correlated with CXCR4 levels in patients with CTO. Patients with low CXCR4 expression exhibited worse clinical outcomes compared with those with high CXCR4 expression. Univariate correlation analysis revealed that age of ≥65 years, women, diabetes, increased plasma level of high-sensitivity C-reactive protein (hs-CRP), and N-terminal brain-type natriuretic peptide were associated with low CXCR4 levels. In conclusion, CXCR4 levels were positively correlated with the presence and extent of angiographic coronary collaterals in patients with CTO. Elder age, women, diabetes, increased plasma level of high-sensitivity C-reactive protein, and N-terminal brain-type natriuretic peptide may be risk factors of CXCR4 expression.
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Association of serum mimecan with angiographic coronary collateralization in patients with stable coronary artery disease and chronic total occlusion. Atherosclerosis 2016; 252:75-81. [PMID: 27508318 DOI: 10.1016/j.atherosclerosis.2016.07.916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Mimecan/osteoglycin is identified as an emerging biomarker of coronary atherosclerosis. We investigated whether and to what extent serum mimecan reflects angiographic coronary collateralization in patients with stable coronary artery disease and chronic total occlusion. METHODS Serum levels of mimecan were determined in 559 consecutive patients with stable angina and angiographic total occlusion of at least one major coronary artery. The degree of collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded as poor (Rentrop score of 0 or 1) or good coronary collateralization (Rentrop score of 2 or 3). RESULTS Serum mimecan was significantly higher in patients with poor collateralization than in those with good collateralization, and correlated inversely with Rentrop score (adjusted Spearmen's r = -0.443, p < 0.001). The prevalence of poor coronary collaterals increased stepwise from the lowest to the highest quartile of serum mimecan (OR 2.140, 95% CI 1.793-2.555; p for trend < 0.001). After adjusting for age, gender, traditional risk factors for coronary artery disease, history of myocardial infarction, severity of coronary artery disease, renal function and C-reactive protein, serum mimecan (per SD) remained an independent determinant for poor collateralization (OR 2.674, 95% CI 2.057-3.475, p < 0.001). The diagnostic value of mimecan (per SD) for detecting poor collateralization was consistent when the patients were specified by gender, age, body mass index, presence or absence of hypertension and diabetes, and status of renal function (OR 2.075-6.932, p interaction ≥ 0.059). CONCLUSION Increased serum mimecan is associated with poor angiographic coronary collateralization in patients with chronic total occlusion.
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Zhong HJ, Wu LH, Chen Y, Chen MH, He XX. Metabolic syndrome is associated with more serious small intestinal mucosal injury. Shijie Huaren Xiaohua Zazhi 2016; 24:1754-1759. [DOI: 10.11569/wcjd.v24.i11.1754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the relationship between metabolic syndrome and small intestinal mucosal injury.
METHODS: Medical data of inpatients who underwent capsule endoscopy at Guangdong Pharmaceutical University from August 2011 to October 2015 were analyzed retrospectively. Different types of mucosal injuries, Lewis score and degree of severity were compared between patients with metabolic syndrome and those without. The effect of different components of metabolic syndrome on small intestinal mucosal injury and the relation between insulin resistance and Lewis score were assessed.
RESULTS: Medical data of 179 patients could be used for analysis. Thirty-four patients with metabolic syndrome were included in a metabolic syndrome group, and 145 patients without metabolic syndrome were included in a control group. The prevalence of villous edema was significantly higher in the metabolic syndrome group (70.6% vs 33.1%, χ2 = 16.10, P < 0.001), but the incidence of ulcers showed no significant difference (8.8% vs 4.8%, P = 0.404). In the metabolic syndrome group, Lewis score was also significantly higher (76.62 ± 81.55 vs 43.59 ± 86.96, t = -2.016, P < 0.001). The Lewis score of patients with hyperglycemia was 34.242 ± 17.263, which was higher than that of patients without hyperglycemia (t = 1.984, P = 0.048). A higher homeostasis model assessment of insulin resistance value was associated with a higher Lewis score (B = 8.173, t = 2.173, P = 0.032).
CONCLUSION: Metabolic syndrome may be a risk factor for small intestinal mucosal injury. Hyperglycemia may be the most effective component of metabolic syndrome for inducing small intestinal mucosal injury.
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Association of blood pressure and coronary collateralization in type 2 diabetic and nondiabetic patients with stable angina and chronic total occlusion. J Hypertens 2016; 33:621-6; discussion 626. [PMID: 25490709 DOI: 10.1097/hjh.0000000000000455] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We investigated whether and to what extent blood pressure (BP) affects coronary collateralization in type 2 diabetic and nondiabetic patients with stable angina and chronic total occlusion. METHODS Brachial BP was measured using an inflatable cuff manometer in 431 diabetic and 287 nondiabetic patients with stable angina and angiographic total occlusion of at least one major coronary artery. They were classified according to the SBP (<100, 100-119, 120-139, 140-159, 160-179, and ≥180 mmHg), DBP (<60, 60-69, 70-79, 80-89, 90-99, and ≥100 mmHg), and pulse (<40, 40-49, 50-59, 60-69, 70-79, and ≥80 mmHg) BP ranges. The degree of coronary collaterals supplying the distal aspect of a total occlusion from the contralateral vessel was graded as poor (Rentrop score of 0 or 1) or good collateralization (Rentrop score of 2 or 3). RESULTS In diabetic patients, the incidence of poor collateralization was related to the DBP in a U-shaped pattern, with the lowest risk at 80-89 mmHg. In nondiabetic patients, an optimal DBP range was 90-99 mmHg for good collaterals, but no U-shaped relation between DBP and coronary collateralization was observed. After adjusting for the baseline characteristics in the logistic regression models, the increased risk of poor collateralization persisted for low or high DBP ranges in diabetic [odds ratio (OR) 2.02-7.29, P ≤ 0.04] and nondiabetic patients (OR 3.62-5.98, P ≤ 0.02). No such relations were observed between collateral grades and SBP and pulse BP. CONCLUSION This study demonstrates that 80-89 and 90-99 mmHg are the optimal ranges for DBP in diabetic and nondiabetic patients with stable angina and chronic total occlusion, within which the risk of poor collateralization is low.
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Serum Cystatin C Reflects Angiographic Coronary Collateralization in Stable Coronary Artery Disease Patients with Chronic Total Occlusion. PLoS One 2015; 10:e0137253. [PMID: 26402227 PMCID: PMC4581619 DOI: 10.1371/journal.pone.0137253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/13/2015] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We investigated whether and to what extent cystatin C was associated with angiographic coronary collateralization in patients with stable coronary artery disease and chronic total occlusion. METHODS Serum levels of cystatin C and high-sensitive C-reactive protein (hsCRP) and glomerular filtration rate (GFR) were determined in 866 patients with stable angina and angiographic total occlusion of at least one major coronary artery. The degree of collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded as poor (Rentrop score of 0 or 1) or good coronary collateralization (Rentrop score of 2 or 3). RESULTS In total, serum cystatin C was higher in patients with poor collateralization than in those with good collateralization (1.08 ± 0.32 mg/L vs. 0.90 ± 0.34 mg/L, P < 0.001), and correlated inversely with Rentrop score (adjusted Spearmen's r = -0.145, P < 0.001). The prevalence of poor coronary collateralization increased stepwise with increasing cystatin C quartiles (P for trend < 0.001). After adjusting for age, gender, risk factors for coronary artery disease, GFR and hsCRP, serum cystatin C ≥ 0.97 mg/L remained independently associated with poor collateralization (OR 2.374, 95% CI 1.660 ~ 3.396, P < 0.001). The diagnostic value of cystatin C levels for detecting poor coronary collateralization persisted regardless of age, gender, presence or absence of diabetes, hypertension or renal dysfunction. CONCLUSIONS Serum cystatin C reflects angiographic coronary collateralization in patients with stable coronary artery disease, and cystatin C ≥ 0.97 mg/L indicates a great risk of poor coronary collaterals.
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Liu X, Sun X, Liao H, Dong Z, Zhao J, Zhu H, Wang P, Shen L, Xu L, Ma X, Shen C, Fan F, Wang C, Hu K, Zou Y, Ge J, Ren J, Sun A. Mitochondrial Aldehyde Dehydrogenase 2 Regulates Revascularization in Chronic Ischemia: Potential Impact on the Development of Coronary Collateral Circulation. Arterioscler Thromb Vasc Biol 2015; 35:2196-206. [PMID: 26315408 DOI: 10.1161/atvbaha.115.306012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/30/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Revascularization is an essential process to compensate for cardiac underperfusion and, therefore, preserves cardiac function in the face of chronic ischemic injury. Recent evidence suggested a vital role of aldehyde dehydrogenase 2 (ALDH2) in cardiac protection after ischemia. This study was designed to determine whether ALDH2 regulates chronic ischemia-induced angiogenesis and to explore the underlying mechanism involved. Moreover, the clinical impact of the ALDH2 mutant allele on the development of coronary collateral circulation (CCC) was evaluated. APPROACH AND RESULTS Mice limb ischemia was performed. Compared with wild-type, ALDH2 deletion significantly reduced perfusion recovery, small artery and capillary density, and increased muscle atrophy in this ischemic model. In vitro, ALDH2-knockdown reduced proliferation, migration and hypoxia triggered endothelial tube formation of endothelial cells, the effects of which were restored by ALDH2 transfection. Further examination revealed that ALDH2 regulated angiogenesis possibly through hypoxia-inducible factor-1α/vascular endothelial growth factor pathways. To further discern the role of ALDH2 deficiency in the function of bone marrow stem/progenitor cells, cross bone marrow transplantation was performed between wild-type and ALDH2-knockout mice. However, there was no significant improvement for wild-type bone marrow transplantation into knockout mice. ALDH2 genotyping was screened in 139 patients with chronic total occlusion recruited to Zhongshan Hospital (2011.10-2014.4). Patients with poor CCC (Rentrop 0-1; n=51) exhibited a higher frequency of the AA genotype than those with enriched CCC (Rentrop 2-3; n=88; 11.76% versus 1.14%; P=0 0.01). However, the AA group displayed less enriched CCC frequency in Logistic regression model when compared with the GG group (odds ratio=0.08; 95% confidence interval, 0.009-0.701; P=0 0.026). Furthermore, serum vascular endothelial growth factor level tended to be lower in patients with ALDH2 mutation. CONCLUSIONS This study demonstrated that ALDH2 possesses an intrinsic capacity to regulate angiogenesis via hypoxia-inducible factor-1α and vascular endothelial growth factor. Patients with ALDH2-deficient genotype displayed a higher risk of developing poor CCC. Therapeutic individualization based on ALDH2 allele distribution may thus improve the therapeutic benefit, especially in the East Asian decedents.
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Affiliation(s)
- Xiangwei Liu
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Xiaolei Sun
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Hua Liao
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Zhen Dong
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Jingjing Zhao
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Hong Zhu
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Peng Wang
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Li Shen
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Lei Xu
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Xin Ma
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Cheng Shen
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Fan Fan
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Cong Wang
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Kai Hu
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Yunzeng Zou
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Junbo Ge
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Jun Ren
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.)
| | - Aijun Sun
- From the Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (X.L., H.Z., P.W., L.S., L.X., C.S., F.F., C.W., K.H., Y.Z., J.G., J.R., A.S.), Institute of Biomedical Science (X.S., L.X., X.M., Y.Z., J.G., A.S.), Department of Cardiology, Huashan Hospital (Z.D.), Fudan University, Shanghai, P.R. China; Center for Cardiovascular Research and Alternative Medicine, School of Pharmacy, University of Wyoming College of Health Sciences, Laramie (X.L., J.R.); Dongfang Hospital, Tongji University, Shanghai, P.R. China (H.L.); and Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China (J.Z.).
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Mukai N, Ninomiya T, Hata J, Hirakawa Y, Ikeda F, Fukuhara M, Hotta T, Koga M, Nakamura U, Kang D, Kitazono T, Kiyohara Y. Association of hemoglobin A1c and glycated albumin with carotid atherosclerosis in community-dwelling Japanese subjects: the Hisayama Study. Cardiovasc Diabetol 2015; 14:84. [PMID: 26099223 PMCID: PMC4482030 DOI: 10.1186/s12933-015-0247-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/16/2015] [Indexed: 12/11/2022] Open
Abstract
Background It is not clear which glucose measure is more useful in the assessment of atherosclerosis. We investigated the associations of hemoglobin A1c (HbA1c), glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), fasting plasma glucose (FPG), and 2-hour postload glucose (PG) with carotid intima-media thickness (IMT) in community-dwelling Japanese subjects. Methods A total of 2702 subjects aged 40–79 years underwent a 75-g oral glucose tolerance test and measurements of HbA1c, GA, 1,5-AG, and carotid IMT by ultrasonography in 2007–2008. Carotid wall thickening was defined as a maximum IMT of >1.0 mm. The crude and multivariable-adjusted linear and logistic regression models were used to analyze cross-sectional associations between levels of glycemic measures and carotid IMT. Results The crude average of the maximum IMT increased significantly with rising quartiles of HbA1c, GA, FPG, and 2-hour PG levels in subjects with and without glucose intolerance (GI), while no clear association was observed for 1,5-AG. After adjustment for other confounding factors, positive trends for HbA1c, GA, and FPG (all p for trend < 0.05), but not 2-hour PG (p = 0.07) remained robust in subjects with GI, but no such associations were found in those without GI. When estimating multivariable-adjusted β values for the associations of 1 SD change in glycemic measures with the maximum IMT in subjects with GI, the magnitude of the influence of HbA1c (β = 0.021), GA (β = 0.024), and FPG (β = 0.024) was larger than that of 2-hour PG (β = 0.014) and 1,5-AG (β = 0.003). The multivariable-adjusted odds ratios for the presence of carotid wall thickening increased significantly with elevating HbA1c, GA, and FPG levels only in subjects with GI (all p for trend < 0.001). Among subjects with GI, the area under the receiver operating characteristic curve significantly increased by adding HbA1c (p = 0.04) or GA (p = 0.04), but not 1,5-AG, FPG, or 2-hour PG, to the model including other cardiovascular risk factors. Conclusions In community-dwelling Japanese subjects with GI, elevated HbA1c, GA, and FPG levels were significantly associated with increased carotid IMT, and HbA1c and GA provided superior discrimination for carotid wall thickening compared to 1,5-AG, FPG, and 2-hour PG, suggesting that HbA1c and GA are useful for assessing carotid atherosclerosis. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0247-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naoko Mukai
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Toshiharu Ninomiya
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Jun Hata
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yoichiro Hirakawa
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Fumie Ikeda
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Masayo Fukuhara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Taeko Hotta
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, Fukuoka, Japan.
| | - Masafumi Koga
- Department of Internal Medicine, Kawanishi City Hospital, Hyogo, Japan.
| | - Udai Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Dongchon Kang
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, Fukuoka, Japan.
| | - Takanari Kitazono
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yutaka Kiyohara
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Yoon HJ, Lee YH, Kim SR, Rim TH, Lee EY, Kang ES, Cha BS, Lee HC, Lee BW. Glycated albumin and the risk of micro- and macrovascular complications in subjects with type 1 diabetes. Cardiovasc Diabetol 2015; 14:53. [PMID: 25975731 PMCID: PMC4438622 DOI: 10.1186/s12933-015-0219-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/22/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We investigated the relationship between the glycemic indices glycated albumin (GA) and glycated hemoglobin (HbA1c) and the progression of diabetic vascular complications [diabetic nephropathy (DN) and carotid artery atherosclerosis (CAA)] in subjects with type 1 diabetes (T1D). METHODS A total of 154 participants with a median follow-up of 2.8 years were enrolled in this retrospective longitudinal study. We recruited T1D subjects who had regularly measured urine albumin-creatinine ratios and estimated glomerular filtration rates, as well as tested HbA1c and GA levels consecutively every 3 or 6 months. A subgroup of 54 subjects was measured repeated carotid intima-media thickness (IMT). RESULTS We classified subjects into the DN progression (Group I; n = 30) with either deteriorated stages of chronic kidney disease (n = 18) or albuminuria progression (n = 17), and the non-progression (Group II; n = 124). In multiple logistic regression analyses, baseline albuminuria (odds ratio [OR] = 2.64, 95 % confidence interval [CI] = 1.03-6.74), mean GA levels (OR = 2.03, 95 % CI = 1.27-3.26) were significantly associated with progression of DN. However, there was no association with mean HbA1c (OR = 0.98, 95 % CI = 0.62-1.54). In a subgroup analysis for follow-up measurements of carotid IMT, age was independently associated with the presence of plaque and the mean IMT. However glycemic indices were not significantly associated with CAA. CONCLUSIONS Mean GA levels were more closely associated with DN progression than mean HbA1c in subjects with T1D. However, they were not associated with the CAA.
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Affiliation(s)
- Hye-jin Yoon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Yong-ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - So Ra Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Tyler Hyungtaek Rim
- Severance Hospital, Seoul, Korea, , 120-752. .,Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea, , 120-752.
| | - Eun Young Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Bong-soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Hyun Chul Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Byung-wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
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Shen Y, Ding FH, Sun JT, Pu LJ, Zhang RY, Zhang Q, Chen QJ, Shen WF, Lu L. Association of elevated apoA-I glycation and reduced HDL-associated paraoxonase1, 3 activity, and their interaction with angiographic severity of coronary artery disease in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2015; 14:52. [PMID: 25964115 PMCID: PMC4432963 DOI: 10.1186/s12933-015-0221-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/30/2015] [Indexed: 11/10/2022] Open
Abstract
Objective To investigate whether apolipoprotein A (apoA)-I glycation and paraoxonase (PON) activities are associated with the severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). Methods Relative intensity of apoA-I glycation and activities of high-density lipoprotein (HDL)-associated PON1 and PON3 were determined in 205 consecutive T2DM patients with stable angina with (n = 144) or without (n = 61) significant CAD (luminal diameter stenosis ≥ 70 %). The severity of CAD was expressed by number of diseased coronary arteries, extent index, and cumulative coronary stenosis score (CCSS). Results The relative intensity of apoA-I glycation was higher but the activities of HDL-associated PON1 and PON3 were lower in diabetic patients with significant CAD than in those without. The relative intensity of apoA-I glycation increased but the activities of HDL-associated PON1 and PON3 decreased stepwise from 1 - to 3 - vessel disease patients (P for trend < 0.001). After adjusting for possible confounding variables, the relative intensity of apoA-I glycation correlated positively, while the activities of HDL-associated PON1 and PON3 negatively, with extent index and CCSS, respectively. At high level of apoA-I glycation (8.70 ~ 12.50 %), low tertile of HDL-associated PON1 (7.03 ~ 38.97U/mL) and PON3 activities (7.11 ~ 22.30U/mL) was associated with a 1.97− and 2.49− fold increase of extent index and 1.73− and 2.68− fold increase of CCSS compared with high tertile of HDL-associated PON1 (57.85 ~ 154.82U/mL) and PON3 activities (39.63 ~ 124.10U/mL), respectively (all P < 0.01). Conclusions Elevated apoA-I glycation and decreased activities of HDL-associated PON1 and PON3, and their interaction are associated with the presence and severity of CAD in patients with T2DM. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0221-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
| | - Jia Teng Sun
- Institute of Cardiovascular Disease, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
| | - Li Jin Pu
- Institute of Cardiovascular Disease, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
| | - Qi Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
| | - Qiu Jing Chen
- Institute of Cardiovascular Disease, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Disease, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Disease, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
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31
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Ma X, Hu X, Zhou J, Hao Y, Luo Y, Lu Z, Bao Y, Jia W. Glycated albumin is more closely correlated with coronary artery disease than 1,5-anhydroglucitol and glycated hemoglobin A1c. Cardiovasc Diabetol 2015; 14:16. [PMID: 25851542 PMCID: PMC4334610 DOI: 10.1186/s12933-014-0166-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/27/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the associations of two nontraditional glycemic markers, glycated albumin (GA) and 1,5-anhydroglucitol (1,5-AG), as well as glycated hemoglobin A1c (HbA1c) with coronary artery disease (CAD). METHODS In total, 272 subjects (178 men and 94 postmenopausal women) were enrolled in this study. All of them underwent coronary angiography which was used to diagnose CAD. The severity of coronary artery stenosis was assessed by the coronary stenosis index (CSI). GA and 1,5-AG were assayed using the enzymatic method, and HbA1c was detected by high-pressure liquid chromatography. RESULTS The HbA1c and GA levels were significantly higher in CAD group than those in non-CAD group (both P < 0.01). While the 1,5-AG level was significantly lower in CAD group than that in non-CAD group (P < 0.05). After adjustment for traditional risk factors of CAD, HbA1c, 1,5-AG, and GA, multivariate logistic regression analysis showed that GA was an independent risk factor for CAD (odds ratio = 1.143, 95% confidence interval: 1.048-1.247, P = 0.002). With CSI as a dependent variable, multiple stepwise regression analysis demonstrated an independent positive correlation between GA and CSI (standardized β = 0.184, P = 0.003), beyond gender, age, and lipid-lowering therapy, after adjustment for traditional risk factors of CAD, HbA1c, 1,5-AG, and GA. CONCLUSIONS GA was more closely correlated with CAD than HbA1c and 1,5-AG in a Chinese population with high risk of CAD.
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Increased serum level of CTRP1 is associated with low coronary collateralization in stable angina patients with chronic total occlusion. Int J Cardiol 2014; 174:203-6. [DOI: 10.1016/j.ijcard.2014.03.205] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/31/2014] [Indexed: 01/27/2023]
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Parrinello CM, Selvin E. Beyond HbA1c and glucose: the role of nontraditional glycemic markers in diabetes diagnosis, prognosis, and management. Curr Diab Rep 2014; 14:548. [PMID: 25249070 PMCID: PMC4214073 DOI: 10.1007/s11892-014-0548-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fasting glucose and hemoglobin A1c (HbA1c) are the standard measures for diagnosis and monitoring of diabetes. There has been recent interest in nontraditional markers of hyperglycemia, including fructosamine, glycated albumin, and 1,5-anhydroglucitol (1,5-AG), as alternatives or adjuncts to standard measures. There is a growing literature linking these nontraditional markers with microvascular and macrovascular complications. Fructosamine and glycated albumin have also been shown to improve identification of persons with diabetes. However, long-term prospective studies with clinical outcomes are lacking. Some modern laboratory assays for fructosamine, glycated albumin, and 1,5-AG have excellent performance. Expanded use of these tests has the potential to improve diabetes care as these measures may overcome limitations of HbA1c in certain patients, complement traditional measures by providing additional information on shorter-term glycemic control, and improve risk stratification for diabetes and its complications. Nonetheless, studies are needed to demonstrate if their routine use will benefit patients and improve outcomes.
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Affiliation(s)
- Christina M Parrinello
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA,
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