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Wan JF, Chen Y, Yao TH, Wu YZ, Dai HZ. Impact of body mass index on adverse kidney events in diabetes mellitus patients: A systematic-review and meta-analysis. World J Clin Cases 2024; 12:538-550. [PMID: 38322463 PMCID: PMC10841950 DOI: 10.12998/wjcc.v12.i3.538] [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] [Received: 10/24/2023] [Revised: 12/10/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The incidence of chronic kidney disease among patients with diabetes mellitus (DM) remains a global concern. Long-term obesity is known to possibly influence the development of type 2 diabetes mellitus. However, no previous meta-analysis has assessed the effects of body mass index (BMI) on adverse kidney events in patients with DM. AIM To determine the impact of BMI on adverse kidney events in patients with DM. METHODS A systematic literature search was performed on the PubMed, ISI Web of Science, Scopus, Ovid, Google Scholar, EMBASE, and BMJ databases. We included trials with the following characteristics: (1) Type of study: Prospective, retrospective, randomized, and non-randomized in design; (2) participants: Restricted to patients with DM aged ≥ 18 years; (3) intervention: No intervention; and (4) kidney adverse events: Onset of diabetic kidney disease [estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2 and/or microalbuminuria value of ≥ 30 mg/g Cr], serum creatinine increase of more than double the baseline or end-stage renal disease (eGFR < 15 mL/min/1.73 m2 or dialysis), or death. RESULTS Overall, 11 studies involving 801 patients with DM were included. High BMI (≥ 25 kg/m2) was significantly associated with higher blood pressure (BP) [systolic BP by 0.20, 95% confidence interval (CI): 0.15-0.25, P < 0.00001; diastolic BP by 0.21 mmHg, 95%CI: 0.04-0.37, P = 0.010], serum albumin, triglycerides [standard mean difference (SMD) = 0.35, 95%CI: 0.29-0.41, P < 0.00001], low-density lipoprotein (SMD = 0.12, 95%CI: 0.04-0.20, P = 0.030), and lower high-density lipoprotein (SMD = -0.36, 95%CI: -0.51 to -0.21, P < 0.00001) in patients with DM compared with those with low BMIs (< 25 kg/m2). Our analysis showed that high BMI was associated with a higher risk ratio of adverse kidney events than low BMI (RR: 1.22, 95%CI: 1.01-1.43, P = 0.036). CONCLUSION The present analysis suggested that high BMI was a risk factor for adverse kidney events in patients with DM.
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Affiliation(s)
- Jing-Fang Wan
- Department of Nephrology, Army Medical University, Chongqing 400042, China
| | - Yan Chen
- Department of Nephrology, Chongqing Western Hospital, Chongqing 400052, China
| | - Tian-Hua Yao
- Health Statistics, Army Medical University, Chongqing 400038, China
| | - Ya-Zhou Wu
- Health Statistics, Army Medical University, Chongqing 400038, China
| | - Huan-Zi Dai
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing 400042, China
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Karadeniz FÖ, Sancaktepe EA, Karadeniz Y. High Triglyceride-Glucose Index is Associated With Poor Prognosis in Patients With Acute Coronary Syndrome in Long-Term Follow-Up. Angiology 2023; 74:139-148. [PMID: 36112779 DOI: 10.1177/00033197221124763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The triglyceride-glucose (TyG) index is calculated from fasting triglycerides and fasting glucose levels and is an indicator of insulin resistance. The present study investigates whether the TyG index has a role in predicting clinical outcomes in cases of acute coronary syndrome (ACS). This retrospective study included 646 patients with ST-elevation myocardial infarction (STEMI) and 1048 patients with non-ST-elevation myocardial infarction (NSTEMI). The association between major adverse cardiac events (MACEs) that developed in-hospital and at 60 months of follow-up and TyG index values were compared. Patients were divided into 2 groups: TyG index values of ≥8.65 and <8.65. During the hospital stay and 60 months of follow-up, 303 MACEs occurred. In both the STEMI and NSTEMI groups, as the TyG index increased, an increase was observed in MACE rates. MACE rates were also found to be highest in the group with TyG index ≥8.65 (P < .001). TyG index, C-reactive protein, and age were independent predictors of MACEs in both the NSTEMI and STEMI groups. The present study found a significant association between higher TyG index values and increased risk of MACEs in ACS patients. The TyG index may prove useful to predict clinical outcomes in ACS patients.
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Affiliation(s)
- Fatma Özpamuk Karadeniz
- Associate Prof, Faculty of Medicine, Department of Cardiology, 166263Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Emine Altuntaş Sancaktepe
- Department of Cardiology, 567570Professor Dr İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Yusuf Karadeniz
- Meram Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, 64222Necmettin Erbakan University, Konya, Turkey
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Emerging Biomarkers for Predicting Clinical Outcomes in Patients with Heart Disease. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010230. [PMID: 36676179 PMCID: PMC9864006 DOI: 10.3390/life13010230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/31/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
Cardiovascular disease is most frequently caused by the development and progression of atherosclerosis. When coronary arteries are afflicted, and the stenoses caused by atherosclerotic plaques are severe enough, the metabolic supply-and-offer balance is disturbed, leading to myocardial ischemia. If atherosclerotic plaques become unstable and local thrombosis develops, a myocardial infarction occurs. Sometimes, myocardial ischemia and infarction may result in significant and irreversible heart failure. To prevent severe complications, such as acute coronary syndromes and ischemia-related heart failure, extensive efforts have been made for developing biomarkers that would help identify patients at increased risk for cardiovascular events. In this two-part study, we attempted to provide a review of existing knowledge of blood biomarkers that may be used in this setting. The first part of this work was dedicated to conventional biomarkers, which are already used in clinical practice. In the second part, here presented, we discuss emerging biomarkers which have not yet become mainstream.
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Yang J, Zheng Y, Li C, Gao J, Meng X, Zhang K, Wang W, Shao C, Tang YD. The Impact of the Stress Hyperglycemia Ratio on Short-term and Long-term Poor Prognosis in Patients With Acute Coronary Syndrome: Insight From a Large Cohort Study in Asia. Diabetes Care 2022; 45:947-956. [PMID: 35045167 DOI: 10.2337/dc21-1526] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In recent years, some studies have indicated that a novel marker described as the stress hyperglycemia ratio (SHR) can reflect true acute hyperglycemic status and is associated with the short-term poor prognosis in patients with acute myocardial infarction. In the current study we evaluated the association of SHR with adverse cardiovascular events among patients with acute coronary syndrome (ACS). RESEARCH DESIGN AND METHODS We consecutively enrolled 5,562 ACS patients who underwent drug-eluting stent (DES) implantation. All subjects were divided into five groups according to SHR, which was determined by the following formula: ABG / [(28.7 × HbA1c %) - 46.7], where ABG is admission blood glucose level. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCE) at the 2-year follow-up, and the secondary end point included major adverse cardiovascular events (MACE) at 2-year follow-up, cardiac death, and nonfatal myocardial infarction (MI) at 2-year follow-up and in-hospital cardiac death and nonfatal MI. RESULTS A total of 643 MACCE were recorded during a median follow-up of 28.3 months. Kaplan-Meier survival analysis showed the lowest MACCE incidence in quintile 3 (P < 0.001). Moreover, the outcomes of restricted cubic spline analysis suggested that there was a U-shaped or J-shaped association between the SHR and early and late cardiovascular outcomes even after adjustment for other confounding factors. CONCLUSIONS There were U-shaped associations of SHR with MACCE rate and MACE rate at 2-year follow-ups and J-shaped associations of SHR with in-hospital cardiac death and MI and that at 2-year follow-up in ACS patients who underwent DES implantation, and the inflection point of SHR for poor prognosis was 0.78.
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Affiliation(s)
- Jie Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yitian Zheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Gao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Xiangbin Meng
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyao Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunli Shao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Yi-Da Tang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
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Wang L, Pan J, Sun Y, Zong S, Zhang R, Li Y, Yu Z, Liu J, Zang S. Increased Neutrophil elastase and proteinase 3 are closely associated with occurrence and severity of stroke and acute myocardial infarction in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2022; 186:109853. [PMID: 35341779 DOI: 10.1016/j.diabres.2022.109853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022]
Abstract
AIMS The role of Neutrophil elastase (NE) and proteinase 3 (PR3) in the occurrence and severity of stroke and acute myocardial infarction (AMI) have not been explored in type 2 diabetes mellitus (T2DM). This study aimed to investigate the relationship and predictive ability of NE and PR3 in the development of stroke and AMI in patients with T2DM, and to explore the pattern of NE and PR3 in atherosclerotic plaques. METHODS 465 patients with T2DM (stroke or AMI, n = 234; non stroke or AMI, n = 231) were recruited. Clinical characteristics, and NE and PR3 concentration were measured in all subjects. Semi-quantitative analysis of immunohistochemistry staining for NE and PR3 was performed in detached emboli and stable plaques. RESULTS Patients with stroke or AMI had a higher level of NE and PR3, with a more pronounced increase in more severe cases (higher mRS score in stroke and Gensini score in AMI) and associated with clinical markers. An increase in NE and PR3 was an independent risk factor for stroke (OR = 4.318, P = 0.017; OR = 2.979, P = 0.048, respectively) and AMI (OR = 8.385, P = 0.015; OR = 5.540, P = 0.047). Finally, immunohistochemistry staining revealed that the NE and PR3 positive area increased significantly in detached emboli compared with stable plaques. CONCLUSION Increased NE and PR3 was associated with occurrence and severity of stroke and AMI in patients with T2DM. Enriched NE and PR3 in detached emboli may be associated with plaque vulnerability.
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Affiliation(s)
- Lihong Wang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Jie Pan
- Department of General Surgery, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Yifan Sun
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Shuhang Zong
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Rui Zhang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Yue Li
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Zhiyan Yu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Jun Liu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China
| | - Shufei Zang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqin Road, Shanghai 200240, China.
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Ye N, Yang L, Wang G, Bian W, Xu F, Ma C, Zhao D, Liu J, Hao Y, Liu J, Yang N, Cheng H. Correction to: Admission fasting plasma glucose is associated with in-hospital outcomes in patients with acute coronary syndrome and diabetes: findings from the improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project. BMC Cardiovasc Disord 2021; 21:349. [PMID: 34294030 PMCID: PMC8296530 DOI: 10.1186/s12872-021-02118-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nan Ye
- Renal Division, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lijiao Yang
- Renal Division, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guoqin Wang
- Renal Division, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weijing Bian
- Renal Division, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fengbo Xu
- Renal Division, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Street, Chao yang District, Beijing, 100029, PR China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Street, Chao yang District, Beijing, 100029, PR China
| | - Yongchen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Street, Chao yang District, Beijing, 100029, PR China
| | - Jun Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Street, Chao yang District, Beijing, 100029, PR China
| | - Na Yang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Street, Chao yang District, Beijing, 100029, PR China
| | - Hong Cheng
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Street, Chao yang District, Beijing, 100029, PR China.
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Li M, Chen G, Feng Y, He X. Stress Induced Hyperglycemia in the Context of Acute Coronary Syndrome: Definitions, Interventions, and Underlying Mechanisms. Front Cardiovasc Med 2021; 8:676892. [PMID: 34055942 PMCID: PMC8149624 DOI: 10.3389/fcvm.2021.676892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023] Open
Abstract
Elevation of glucose level in response to acute coronary syndrome (ACS) has been recognized as stress induced hyperglycemia (SIH). Plenty of clinical studies have documented that SIH occurs very common in patients hospitalized with ACS, even in those without previously known diabetes mellitus. The association between elevated blood glucose levels with adverse outcome in the ACS setting is well-established. Yet, the precise definition of SIH in the context of ACS remains controversial, bringing confusions about clinical management strategy. Several randomized trials aimed to evaluate the effect of insulin-based therapy on outcomes of ACS patients failed to demonstrate a consistent benefit of intensive glucose control. Mechanisms underlying detrimental effects of SIH on patients with ACS are undetermined, oxidative stress might play an important role in the upstream pathways leading to subsequent harmful effects on cardiovascular system. This review aims to discuss various definitions of SIH and their values in predicting adverse outcome in the context of ACS, as well as the effect of intensive glucose control on clinical outcome. Finally, a glimpse of the underlying mechanisms is briefly discussed.
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Affiliation(s)
- Mingmin Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guo Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuyu He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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