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Kawada T, Yamamoto H, Fukumitsu M, Nishikawa T, Matsushita H, Yoshida Y, Sato K, Morita H, Alexander J, Saku K. Acute effects of empagliflozin on open-loop baroreflex function and urine output in streptozotocin-induced type 1 diabetic rats. J Physiol Sci 2024; 74:48. [PMID: 39342112 PMCID: PMC11438138 DOI: 10.1186/s12576-024-00938-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 09/04/2024] [Indexed: 10/01/2024]
Abstract
Although sympathetic suppression is considered one of the mechanisms for cardioprotection afforded by sodium-glucose cotransporter 2 (SGLT2) inhibitors, whether SGLT2 inhibition acutely modifies sympathetic arterial pressure (AP) regulation remains unclear. We examined the acute effect of an SGLT2 inhibitor, empagliflozin (10 mg/kg), on open-loop baroreflex static characteristics in streptozotocin (STZ)-induced type 1 diabetic and control (CNT) rats (n = 9 each). Empagliflozin significantly increased urine flow [CNT: 25.5 (21.7-31.2) vs. 55.9 (51.0-64.5), STZ: 83.4 (53.7-91.7) vs. 121.2 (57.0-136.0) μL·min-1·kg-1, median (1st-3rd quartiles), P < 0.001 for empagliflozin and STZ]. Empagliflozin decreased the minimum sympathetic nerve activity (SNA) [CNT: 15.7 (6.8-18.4) vs. 10.5 (2.9-19.0), STZ: 36.9 (25.7-54.9) vs. 32.8 (15.1-37.5) %, P = 0.021 for empagliflozin and P = 0.003 for STZ], but did not significantly affect the peripheral arc characteristics assessed by the SNA-AP relationship. Despite the significant increase in urine flow and changes in several baroreflex parameters, empagliflozin preserved the overall sympathetic AP regulation in STZ-induced diabetic rats. The lack of a significant change in the peripheral arc may minimize reflex sympathetic activation, thereby enhancing a cardioprotective benefit of empagliflozin.
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Affiliation(s)
- Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, 564-8565, Japan.
| | - Hiromi Yamamoto
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Ohara HealthCare Foundation, Okayama, 710-8602, Japan
| | - Masafumi Fukumitsu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, 564-8565, Japan
| | - Takuya Nishikawa
- Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, 564-8565, Japan
| | - Hiroki Matsushita
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, 564-8565, Japan
| | - Yuki Yoshida
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, 564-8565, Japan
| | - Kei Sato
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, 564-8565, Japan
| | - Hidetaka Morita
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, 564-8565, Japan
| | - Joe Alexander
- Medical and Health Informatics Laboratories, NTT Research, Inc, Sunnyvale, CA, 94085, USA
| | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, 564-8565, Japan
- Bio Digital Twin Center, National Cerebral and Cardiovascular Center, Osaka, 564-8565, Japan
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El Tawil EH, Saliby R, Halabi R, El Khoury J, Assaf S, Hamdan M, Abou Nader G, Abou Jaoude E. Prevalence and associations of asymptomatic left ventricular systolic dysfunction in Lebanese patients with type 2 diabetes mellitus. PLoS One 2024; 19:e0304801. [PMID: 39292729 PMCID: PMC11410251 DOI: 10.1371/journal.pone.0304801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/19/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Diabetes Mellitus is a prevalent disease with a growing impact on individuals worldwide. Evaluating the prevalence of subclinical left ventricular dysfunction and understanding its associations with microvascular complications, uncontrolled glycemia, diabetes duration, and patient age is crucial. Our aim is to determine the utility of screening for this condition. METHODS We conducted a retrospective cohort study involving 159 asymptomatic individuals with type 2 diabetes. Bivariate analysis was employed to assess potential factors and their associations with subclinical left ventricular dysfunction. Patients with a history of cardiac disease or interventions were excluded. RESULTS The average age of our sample was 61.5 years. Almost half of the patients exhibited an HbA1c exceeding 7% (50.3%), and approximately half had an ejection fraction (EF) of less than 55% (50.9%). In the bivariate analysis, a notable difference in microvascular diabetic complications was observed among different EF groups. Specifically, nephropathy (62%), neuropathy (57.5%), and retinopathy (74.4%) were significantly more prevalent among patients with an EF < 55%. We also identified a significant age difference between groups, with a higher mean diabetes duration (14.1 ± 7.7 years) in the lower EF group. Notably, 63.7% of patients with an HbA1c exceeding 7% exhibited an EF < 55%. Older patients were associated with a lower EF, with an adjusted odds ratio (aOR) of 0.94. An HbA1c of 7% or less was linked to a higher likelihood of an EF > 55%. CONCLUSION We established a correlation between subclinical left ventricular systolic dysfunction and microvascular complications. However, further extensive prospective research is necessary to deepen our understanding of these associations and their clinical implications.
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Affiliation(s)
- Elsy Hany El Tawil
- School of Medicine and Medical Sciences, Holy Spirit University Of Kaslik, Kaslik, Lebanon
| | - Rita Saliby
- School of Medicine and Medical Sciences, Holy Spirit University Of Kaslik, Kaslik, Lebanon
| | - Ramy Halabi
- School of Medicine and Medical Sciences, Holy Spirit University Of Kaslik, Kaslik, Lebanon
| | - Joey El Khoury
- School of Medicine and Medical Sciences, Holy Spirit University Of Kaslik, Kaslik, Lebanon
| | - Serge Assaf
- School of Medicine and Medical Sciences, Holy Spirit University Of Kaslik, Kaslik, Lebanon
| | - Mira Hamdan
- School of Medicine and Medical Sciences, Holy Spirit University Of Kaslik, Kaslik, Lebanon
| | - Gilbert Abou Nader
- Faculty of Medicine and Medical Sciences, Department of Internal Medicine, Endocrinology Division, University of Balamand, Koura, Lebanon
| | - Elizabeth Abou Jaoude
- School of Medicine and Medical Sciences, Holy Spirit University Of Kaslik, Kaslik, Lebanon
- Faculty of Medicine and Medical Sciences, Department of Internal Medicine, Endocrinology Division, University of Balamand, Koura, Lebanon
- Department of Internal Medicine, Endocrinology Division, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Jbeil, Lebanon
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Barbieri M, Prattichizzo F, La Grotta R, Matacchione G, Scisciola L, Fontanella RA, Tortorella G, Benedetti R, Carafa V, Marfella R, Ceriello A, Paolisso G. Is it time to revise the fighting strategy toward type 2 diabetes? Sex and pollution as new risk factors. Ageing Res Rev 2024; 99:102405. [PMID: 38971321 DOI: 10.1016/j.arr.2024.102405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
Diabetes mellitus, a metabolic condition affecting around 537 million individuals worldwide, poses significant challenges, particularly among the elderly population. The etiopathogenesis of type 2 diabetes (T2D) depends on a combination of the effects driven by advancing age, genetic background, and lifestyle habits, e.g. overnutrition. These factors influence the development of T2D differently in men and women, with an obvious sexual dimorphism possibly underlying the diverse clinical features of the disease in different sexes. More recently, environmental pollution, estimated to cause 9 million deaths every year, is emerging as a novel risk factor for the development of T2D. Indeed, exposure to atmospheric pollutants such as PM2.5, O3, NO2, and Persistent Organic Pollutants (POP)s, along with their combination and bioaccumulation, is associated with the development of T2D and obesity, with a 15 % excess risk in case of exposure to very high levels of PM2.5. Similar data are available for plasticizer molecules, e.g. bisphenol A and phthalates, emerging endocrine-disrupting chemicals. Even though causality is still debated at this stage, preclinical evidence sustains the ability of multiple pollutants to affect pancreatic function, promote insulin resistance, and alter lipid metabolism, possibly contributing to T2D onset and progression. In addition, preclinical findings suggest a possible role also for plastic itself in the development of T2D. Indeed, pioneeristic studies evidenced that micro- or nanoplastics (MNP)s, particles in the micro- or nano- range, promote cellular damage, senescence, inflammation, and metabolic disturbances, leading to insulin resistance and impaired glucose metabolism in animal and/or in vitro models. Here we synthesize recent knowledge relative to the association between air-related or plastic-derived pollutants and the incidence of T2D, discussing also the possible mechanistic links suggested by the available literature. We then anticipate the need for future studies in the field of candidate therapeutic strategies limiting pollution-induced damage in preclinical models, such as SGLT-2 inhibitors. We finally postulate that future guidelines for T2D prevention should consider pollution and sex an additional risk factors to limit the diabetes pandemic.
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Affiliation(s)
- Michelangela Barbieri
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | - Giulia Matacchione
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60121 Ancona, Italy.
| | - Lucia Scisciola
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Rosaria Anna Fontanella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Tortorella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosaria Benedetti
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Vincenzo Carafa
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy; Biogem, Molecular Biology and Genetics Research Institute, Ariano Irpino 83031, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; UniCamillus, International Medical University, Rome, Italy
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Seinfeld J, Sobrevilla A, Rosales ML, Ibáñez M, Ruiz D, Penny E, Londoño S. Economic burden of type-2 diabetes in Peru: a cost-of-illness study valuing cost differences associated with the level of glycemic control. Expert Rev Pharmacoecon Outcomes Res 2024; 24:661-669. [PMID: 38584495 DOI: 10.1080/14737167.2024.2333337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) represents an increasing public health problem in Peru. This study aims to estimate the national economic burden of this disease for the public funder, the social security, and private sector insurers. METHODS Direct healthcare costs were estimated for a cohort of 45-to-75-year-old adults diagnosed with T2DM in 2019, over a 20-year period. Disease progression was modeled using PROSIT Models and literature, including acute and chronic microvascular and macrovascular complications. Three scenarios of glycemic control were considered: current levels of 35.8% of the population controlled (HbA1c < 7%) (S1); 100% controlled (S2) and; 100% uncontrolled (S3). The impact of diabetes prevalence on overall costs was evaluated in sensitivity analysis. RESULTS Total national economic burden was estimated at $15,405,448,731; an annual average per patient of $2,158. Total costs would decrease to $12,853,113,596 (-16.6%) in S2 and increase to $16,828,713,495 (+9.2%) in S3. Treating patients with complications and risk factors could cost 6.5 times more, being stroke the complication with the highest impact. Up to a 67.6% increase in total costs was found when increasing T2DM prevalence. CONCLUSIONS T2DM places a heavy burden on the Peruvian healthcare budget that will be even greater if poor glycemic control is maintained.
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Affiliation(s)
| | | | | | | | - Delia Ruiz
- Videnza Consultores, Videnza, Lima, Perú
| | | | - Sergio Londoño
- Health Economics & Value Assesment, Sanofi, Bogotá, Colombia
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Echeverría LE, Saldarriaga C, Campbell-Quintero S, Morales-Rodríguez LN, López-Ponce de León JD, Buitrago AF, Martínez-Carreño E, Sandoval-Luna JA, Llamas A, Moreno-Silgado GA, Vanegas-Eljach J, Murillo-Benítez NE, Gómez-Paláu R, Rivera-Toquica AA, Gómez-Mesa JE. Diabetes mellitus in patients with heart failure and effect modification of risk factors for short-term mortality: An observational study from the Registro Colombiano de Falla Cardíaca (RECOLFACA). BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2024; 44:182-197. [PMID: 39079149 PMCID: PMC11368228 DOI: 10.7705/biomedica.6951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/15/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Heart failure and type 2 diabetes mellitus are critical public health issues. OBJECTIVE To characterize the risk factors for mortality in patients with heart failure and type 2 diabetes mellitus from a large registry in Colombia and to evaluate the potential effect modifications by type 2 diabetes mellitus over other risk factors. MATERIALS AND METHODS Heart failure patients with and without type 2 diabetes mellitus enrolled in the Registro Colombiano de Falla Cardíaca (RECOLFACA) were included. RECOLFACA enrolled adult patients with heart failure diagnosis from 60 medical centers in Colombia during 2017-2019. The primary outcome was all-cause mortality. Survival analysis was performed using adjusted Cox proportional hazard models. RESULTS A total of 2514 patients were included, and the prevalence of type 2 diabetes mellitus was 24.7% (n = 620). We found seven independent predictors of short-term mortality for the general cohort, chronic obstructive pulmonary disease, sinus rhythm, triple therapy, nitrates use, statins use, anemia, and hyperkalemia. In the type 2 diabetes mellitus group, only the left ventricle diastolic diameter was an independent mortality predictor (HR = 0.96; 95% CI: 0.93-0.98). There was no evidence of effect modification by type 2 diabetes mellitus on the relationship between any independent predictors and all-cause mortality. However, a significant effect modification by type 2 diabetes mellitus between smoking and mortality was observed. CONCLUSIONS Patients with type 2 diabetes mellitus had higher mortality risk. Our results also suggest that type 2 diabetes mellitus diagnosis does not modify the effect of the independent risk factors for mortality in heart failure evaluated. However, type 2 diabetes mellitus significantly modify the risk relation between mortality and smoking in patients with heart failure.
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Affiliation(s)
- Luis Eduardo Echeverría
- Departamento de Cardiología, Fundación Cardiovascular de Colombia, Bucaramanga, ColombiaFundación Cardiovascular de ColombiaDepartamento de CardiologíaFundación Cardiovascular de ColombiaBucaramangaColombia
| | - Clara Saldarriaga
- Departamento de Cardiología, Clínica Cardio VID, Medellín, ColombiaClínica Cardio VIDDepartamento de CardiologíaClínica Cardio VIDMedellínColombia
| | - Sebastián Campbell-Quintero
- Departamento de Cardiología, Clínica Medilaser, Florencia, ColombiaClínica MedilaserDepartamento de CardiologíaClínica MedilaserFlorenciaColombia
| | - Lisbeth Natalia Morales-Rodríguez
- Departamento de Cardiología, Clínica Medilaser, Neiva, ColombiaClínica MedilaserDepartamento de CardiologíaClínica MedilaserNeivaColombia
| | - Juan David López-Ponce de León
- Departamento de Cardiología, Fundación Valle de Lili, Cali, ColombiaFundación Valle de LiliDepartamento de CardiologíaFundación Valle de LiliCaliColombia
| | - Andrés Felipe Buitrago
- Departamento de Cardiología, Fundación Santa Fe de Bogotá, Bogotá, D.C., ColombiaFundación Santa Fe de BogotáDepartamento de CardiologíaFundación Santa Fe de BogotáBogotá, D.C.Colombia
| | - Erika Martínez-Carreño
- Departamento de Cardiología, Institución Clínica Iberoamérica Sanitas, Barranquilla, ColombiaInstitución Clínica Iberoamérica SanitasDepartamento de CardiologíaInstitución Clínica Iberoamérica SanitasBarranquillaColombia
| | - Jorge Alberto Sandoval-Luna
- Departamento de Cardiología, Cardiología Siglo XXI, Ibagué, ColombiaCardiología Siglo XXIDepartamento de CardiologíaCardiología Siglo XXIIbaguéColombia
| | - Alexis Llamas
- Departamento de Cardiología, Clínica Las Américas, Medellín, ColombiaClínica Las AméricasDepartamento de CardiologíaClínica Las AméricasMedellínColombia
| | - Gustavo Adolfo Moreno-Silgado
- Departamento de Cardiología, Hospicardio, Montería, ColombiaHospicardioDepartamento de CardiologíaHospicardioMonteríaColombia
| | - Julián Vanegas-Eljach
- Departamento de Cardiología, Hospital Alma Máter, Antioquia, ColombiaHospital Alma MáterDepartamento de CardiologíaHospital Alma MáterAntioquiaColombia
| | - Nelson Eduardo Murillo-Benítez
- Departamento de Cardiología, Angiografía de Occidente, Cali, ColombiaAngiografía de OccidenteDepartamento de CardiologíaAngiografía de OccidenteCaliColombia
| | - Ricardo Gómez-Paláu
- Departamento de Cardiología, Clínica Imbanaco-Grupo Quirón Salud, Cali, ColombiaClínica Imbanaco-Grupo Quirón SaludDepartamento de CardiologíaClínica Imbanaco-Grupo Quirón SaludCaliColombia
| | - Alex Arnulfo Rivera-Toquica
- Departamento de Cardiología, Centro Médico para el Corazón, Pereira, ColombiaCentro Médico para el CorazónDepartamento de CardiologíaCentro Médico para el CorazónPereiraColombia
| | - Juan Esteban Gómez-Mesa
- Departamento de Cardiología, Fundación Valle de Lili, Cali, ColombiaFundación Valle de LiliDepartamento de CardiologíaFundación Valle de LiliCaliColombia
- Departamento de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaUniversidad IcesiDepartamento de Ciencias de la SaludUniversidad IcesiCaliColombia
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Izraiq M, Almousa E, Hammoudeh S, Sudqi M, Ahmed YB, Abu-Dhaim OA, Mughrabi Sabbagh AL, Khraim KI, Toubasi AA, Al-Kasasbeh A, Rawashdeh S, Abu-Hantash H. Impact of Diabetes Mellitus on Heart Failure Patients: Insights from a Comprehensive Analysis and Machine Learning Model Using the Jordanian Heart Failure Registry. Int J Gen Med 2024; 17:2253-2264. [PMID: 38779652 PMCID: PMC11110810 DOI: 10.2147/ijgm.s465169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Background Heart failure (HF) is a common final pathway of various insults to the heart, primarily from risk factors including diabetes mellitus (DM) type 2. This study analyzed the clinical characteristics of HF in a Jordanian population with a particular emphasis on the relationship between DM and HF. Methods This prospective study used the Jordanian Heart Failure Registry (JoHFR) data. Patients with HF were characterized by DM status and HF type: HF with preserved ejection fraction (HFpEF) or HF with reduced ejection fraction (HFrEF). Demographics, clinical presentations, and treatment outcomes were collected. Statistical analyses and machine learning techniques were carried out for the prediction of mortality among HF patients: Recursive Feature Elimination with Cross-Validation (RFECV) and Synthetic Minority Over-sampling Technique with Edited Nearest Neighbors (SMOTEENN) were employed. Results A total of 2007 patients with HF were included. Notable differences between diabetic and non-diabetic patients are apparent. Diabetic patients were predominantly male, older, and obese (p < 0.001 for all). A higher incidence of HFpEF was observed in the diabetes cohort (p = 0.006). Also, diabetic patients had significantly higher levels of cholesterol (p = 0.008) and LDL (p = 0.003), reduced hemoglobin levels (p < 0.001), and more severe renal impairment (eGFR; p = 0.006). Machine learning models, particularly the Random Forest Classifier, highlighted its superiority in mortality prediction, with an accuracy of 90.02% and AUC of 80.51%. Predictors of mortality included creatinine levels >115 µmol/L, length of hospital stay, and need for mechanical ventilation. Conclusion This study underscores notable differences in clinical characteristics and outcomes between diabetic and non-diabetic heart failure patients in Jordan. Diabetic patients had higher prevalence of HFpEF and poorer health indicators such as elevated cholesterol, LDL, and impaired kidney function. High creatinine levels, longer hospital stays, and the need for mechanical ventilation were key predictors of mortality.
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Affiliation(s)
- Mahmoud Izraiq
- Cardiology Section, Internal Medicine Department, Specialty Hospital, Amman, Jordan
| | - Eyas Almousa
- Department of Cardiology, Istishari Hospital, Amman, Jordan
| | - Suhail Hammoudeh
- Cardiology Section, Internal Medicine Department, Specialty Hospital, Amman, Jordan
| | - Mazen Sudqi
- Cardiology Section, Internal Medicine Department, Specialty Hospital, Amman, Jordan
| | - Yaman B Ahmed
- Cardiology Section, Internal Medicine Department, King Abdullah University Hospital, Irbid, Jordan
| | - Omran A Abu-Dhaim
- Cardiology Section, Internal Medicine Department, Specialty Hospital, Amman, Jordan
| | | | - Karam I Khraim
- Cardiology Section, Internal Medicine Department, Specialty Hospital, Amman, Jordan
| | - Ahmad A Toubasi
- Cardiology Section, Internal Medicine Department, Jordan University Hospital, Amman, Jordan
| | - Abdullah Al-Kasasbeh
- Cardiology Section, Internal Medicine Department, King Abdullah University Hospital, Irbid, Jordan
| | - Sukaina Rawashdeh
- Cardiology Section, Internal Medicine Department, King Abdullah University Hospital, Irbid, Jordan
| | - Hadi Abu-Hantash
- Department of Cardiology, Amman Surgical Hospital, Amman, Jordan
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Malhotra C, Chaudhry I, Keong YK, Sim KLD. Multifactorial risk factors for hospital readmissions among patients with symptoms of advanced heart failure. ESC Heart Fail 2024; 11:1144-1152. [PMID: 38271260 DOI: 10.1002/ehf2.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/11/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
AIMS Economic burden of heart failure is attributed to hospital readmissions. Previous studies assessing risk factors for readmissions have focused on single group of risk factors, were limited to 30-day readmissions, or did not account for competing risk of mortality. This study investigates the biological, socio-economic, and behavioural risk factors predicting hospital readmissions while accounting for the competing risk of mortality. METHODS AND RESULTS In this prospective cohort study, we recruited 250 patients hospitalized with symptoms of advanced heart failure [New York Heart Association (NYHA) Class III and IV] between July 2017 and April 2019. We analysed their baseline survey data and their hospitalization records over the next 4.5 years (July 2017 to January 2022). We used a joint-frailty model to determine the multifactorial risk factors for all-cause and unplanned hospital readmissions and mortality. At the time of recruitment, patients' mean (SD) age was 66 (12) years, majority being male (72%) and NYHA class IV (68%) with reduced ejection fraction (72%). 87% of the patients had poor self-care behaviours, 51% had diabetes and 56% had weak grip strength. Within 2 years of a hospital admission, 74% of the patients had at least one readmission. Among all readmissions during follow-up, 68% were unplanned. Results from the multivariable regression analysis shows that the independent risk factors for hospital readmissions were biologic-weak grip strength [hazard ratio (95% CI): 1.59 (1.06, 2.13)], poor functional status [1.79 (0.98, 2.61)], diabetes [1.42 (0.97, 1.86)]; behavioural-poor self-care [1.66 (0.84, 2.49)], and socio-economic-preference for maximal life extension at high cost for those with high education [1.98 (1.17, 2.80)]. Risk factors for unplanned hospital readmissions were similar. A higher hospital readmission rate increased the risk of mortality [1.86 (1.23, 2.50)]. Other risk factors for mortality were biologic-weak grip strength [3.65 (0.57, 6.73)], diabetes [2.52 (0.62, 4.42)], socio-economic-lower education [2.45 (0.37, 4.53)], and being married [2.53 (0.37, 4.69)]. Having a private health insurance [0.40 (0.08, 0.73)] lowered the risk for mortality. CONCLUSIONS Risk factors for hospital readmissions and mortality are multifactorial. Many of these factors, such as weak grip strength, diabetes, poor self-care behaviours, are potentially modifiable and should be routinely assessed and managed in cardiac clinics and hospital admissions.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
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Mahtani K, MMath BPBS, Brian Wang M, Barron A. Activation of GLP-1 receptor signalling by sacubitril/valsartan: Implications for patients with poor glycaemic control. Int J Cardiol 2022; 367:81-89. [DOI: 10.1016/j.ijcard.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 12/11/2022]
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Use of Digital Health Technology in Heart Failure and Diabetes: a Scoping Review. J Cardiovasc Transl Res 2022:10.1007/s12265-022-10273-6. [PMID: 35639339 PMCID: PMC9153219 DOI: 10.1007/s12265-022-10273-6] [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] [Received: 02/10/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022]
Abstract
Use of digital health technologies (DHT) in chronic disease management is rising. We aim to evaluate the impact of DHT on clinical outcomes from randomized controlled trials (RCTs) of patients with heart failure (HF) and diabetes mellitus (DM). Electronic databases were searched for DHT RCTs in patients with HF and DM until February 2021. Patient characteristics and outcomes were analyzed. One published (N = 519) and 6 registered (N = 3423) eligible studies were identified, with one study exclusively including HF and DM patients. Median DHT monitoring was 12 months, with six studies using mobile platforms as their key exposure. Clinical outcomes included quality-of-life or self-care surveys (n = 1 each), physical activity metrics, changes in biomarkers, and other clinical endpoints (n = 3). Limited data exist on RCTs evaluating DHT in patients with concomitant HF and DM. Further work should define standardized clinical endpoints and platforms that can manage patients with multiple comorbidities.
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Rampin A, Carrabba M, Mutoli M, Eman CL, Testa G, Madeddu P, Spinetti G. Recent Advances in KEAP1/NRF2-Targeting Strategies by Phytochemical Antioxidants, Nanoparticles, and Biocompatible Scaffolds for the Treatment of Diabetic Cardiovascular Complications. Antioxid Redox Signal 2022; 36:707-728. [PMID: 35044251 DOI: 10.1089/ars.2021.0134] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Significance: Modulation of nuclear factor (erythroid-derived 2)-like 2 (Nrf2)-mediated antioxidant response is a key aspect in the onset of diabetes-related cardiovascular complications. With this review, we provide an overview of the recent advances made in the development of Nrf2-targeting strategies for the treatment of diabetes, with particular attention toward the activation of Nrf2 by natural antioxidant compounds, nanoparticles, and oxidative stress-modulating biocompatible scaffolds. Recent Advances: In the past 30 years, studies addressing the use of antioxidant therapies to treat diabetes have grown exponentially, showing promising but yet inconclusive results. Animal studies and clinical trials on the Nrf2 pathway have shown promising results, suggesting that its activation can delay or reverse some of the cardiovascular impairments in diabetes. Critical Issues: Hyperglycemia- and oscillating glucose levels-induced reactive oxygen species (ROS) accumulation is progressively emerging as a central factor in the onset and progression of diabetes-related cardiovascular complications, including endothelial dysfunction, retinopathy, heart failure, stroke, critical limb ischemia, ulcers, and delayed wound healing. In this context, accumulating evidence suggests a central role for Nrf2-mediated antioxidant response, one of the most studied cellular defensive mechanisms against ROS accumulation. Future Directions: Innovative approaches such as tissue engineering and nanotechnology are converging toward targeting oxidative stress in diabetes. Antioxid. Redox Signal. 36, 707-728.
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Affiliation(s)
- Andrea Rampin
- Laboratory of Cardiovascular Physiopathology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy
| | - Michele Carrabba
- Laboratory of Experimental Cardiovascular Medicine, University of Bristol, Bristol, England, United Kingdom
| | - Martina Mutoli
- Laboratory of Cardiovascular Physiopathology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy
| | - Charlotte L Eman
- Laboratory of Cardiovascular Physiopathology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy
| | - Gianluca Testa
- Department of Medicine and Health Sciences, "V. Tiberio" University of Molise, Campobasso, Italy.,Interdepartmental Center for Nanotechnology Research-NanoBem, University of Molise, Campobasso, Italy
| | - Paolo Madeddu
- Laboratory of Experimental Cardiovascular Medicine, University of Bristol, Bristol, England, United Kingdom
| | - Gaia Spinetti
- Laboratory of Cardiovascular Physiopathology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy
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11
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Williams RD, Reps JM, Kors JA, Ryan PB, Steyerberg E, Verhamme KM, Rijnbeek PR. Using Iterative Pairwise External Validation to Contextualize Prediction Model Performance: A Use Case Predicting 1-Year Heart Failure Risk in Patients with Diabetes Across Five Data Sources. Drug Saf 2022; 45:563-570. [PMID: 35579818 PMCID: PMC9114056 DOI: 10.1007/s40264-022-01161-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION External validation of prediction models is increasingly being seen as a minimum requirement for acceptance in clinical practice. However, the lack of interoperability of healthcare databases has been the biggest barrier to this occurring on a large scale. Recent improvements in database interoperability enable a standardized analytical framework for model development and external validation. External validation of a model in a new database lacks context, whereby the external validation can be compared with a benchmark in this database. Iterative pairwise external validation (IPEV) is a framework that uses a rotating model development and validation approach to contextualize the assessment of performance across a network of databases. As a use case, we predicted 1-year risk of heart failure in patients with type 2 diabetes mellitus. METHODS The method follows a two-step process involving (1) development of baseline and data-driven models in each database according to best practices and (2) validation of these models across the remaining databases. We introduce a heatmap visualization that supports the assessment of the internal and external model performance in all available databases. As a use case, we developed and validated models to predict 1-year risk of heart failure in patients initializing a second pharmacological intervention for type 2 diabetes mellitus. We leveraged the power of the Observational Medical Outcomes Partnership common data model to create an open-source software package to increase the consistency, speed, and transparency of this process. RESULTS A total of 403,187 patients from five databases were included in the study. We developed five models that, when assessed internally, had a discriminative performance ranging from 0.73 to 0.81 area under the receiver operating characteristic curve with acceptable calibration. When we externally validated these models in a new database, three models achieved consistent performance and in context often performed similarly to models developed in the database itself. The visualization of IPEV provided valuable insights. From this, we identified the model developed in the Commercial Claims and Encounters (CCAE) database as the best performing model overall. CONCLUSION Using IPEV lends weight to the model development process. The rotation of development through multiple databases provides context to model assessment, leading to improved understanding of transportability and generalizability. The inclusion of a baseline model in all modelling steps provides further context to the performance gains of increasing model complexity. The CCAE model was identified as a candidate for clinical use. The use case demonstrates that IPEV provides a huge opportunity in a new era of standardised data and analytics to improve insight into and trust in prediction models at an unprecedented scale.
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Affiliation(s)
- Ross D. Williams
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jenna M. Reps
- Janssen Research and Development, Titusville, NJ USA
| | - Jan A. Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | | | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katia M. Verhamme
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Peter R. Rijnbeek
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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12
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Mohan M, Dihoum A, Mordi IR, Choy AM, Rena G, Lang CC. Left Ventricular Hypertrophy in Diabetic Cardiomyopathy: A Target for Intervention. Front Cardiovasc Med 2021; 8:746382. [PMID: 34660744 PMCID: PMC8513785 DOI: 10.3389/fcvm.2021.746382] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022] Open
Abstract
Heart failure is an important manifestation of diabetic heart disease. Before the development of symptomatic heart failure, as much as 50% of patients with type 2 diabetes mellitus (T2DM) develop asymptomatic left ventricular dysfunction including left ventricular hypertrophy (LVH). Left ventricular hypertrophy (LVH) is highly prevalent in patients with T2DM and is a strong predictor of adverse cardiovascular outcomes including heart failure. Importantly regression of LVH with antihypertensive treatment especially renin angiotensin system blockers reduces cardiovascular morbidity and mortality. However, this approach is only partially effective since LVH persists in 20% of patients with hypertension who attain target blood pressure, implicating the role of other potential mechanisms in the development of LVH. Moreover, the pathophysiology of LVH in T2DM remains unclear and is not fully explained by the hyperglycemia-associated cellular alterations. There is a growing body of evidence that supports the role of inflammation, oxidative stress, AMP-activated kinase (AMPK) and insulin resistance in mediating the development of LVH. The recognition of asymptomatic LVH may offer an opportune target for intervention with cardio-protective therapy in these at-risk patients. In this article, we provide a review of some of the key clinical studies that evaluated the effects of allopurinol, SGLT2 inhibitor and metformin in regressing LVH in patients with and without T2DM.
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Affiliation(s)
- Mohapradeep Mohan
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Adel Dihoum
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Anna-Maria Choy
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Graham Rena
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.,UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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13
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Diabetes Mellitus and Heart Failure. J Clin Med 2021; 10:jcm10163682. [PMID: 34441977 PMCID: PMC8396967 DOI: 10.3390/jcm10163682] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus (DM) is a major risk factor for new-onset heart failure (HF) and vice versa. The pathogenesis of new-onset HF in DM is complex and has been largely attributed to the toxic cardiovascular effects of hyperglycemia and relevant metabolic abnormalities (diabetic cardiomyopathy) as well as the frequently coexisting morbidities such as hypertension (HTN), coronary artery disease (CAD), and diabetic nephropathy. In patients with type 1 DM (T1DM), HF develops in the setting of a dysregulated immune response, whereas in most patients with type 2 DM (T2DM), against a background of overweight/obesity. HF prevention in DM is feasible with rigorous treatment of cardiovascular risk factors and selective antidiabetic agents. Conversely, development of new-onset T2DM in HF (cardiogenic DM) is common and has been attributed to an increase in the resistance to insulin, especially in the skeletal muscle, liver, and adipose tissue as well as in diminished insulin secretory response to hyperglycemia by pancreatic β-cells. Cardiogenic DM further deteriorates cardiac dysfunction and adversely affects outcome in HF. Novel lifesaving medications employed in HF management such as sacubitril/valsartan and sodium glucose cotransporter 2 inhibitors (SGLT-2i) have a favorable metabolic profile and lower the incidence of cardiogenic diabetes. Whether mitigation of cardiogenic DM should be a treatment target in HF deserves further investigation.
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14
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Gager GM, Gelbenegger G, Jilma B, von Lewinski D, Sourij H, Eyileten C, Filipiak K, Postula M, Siller-Matula JM. Cardiovascular Outcome in Patients Treated With SGLT2 Inhibitors for Heart Failure: A Meta-Analysis. Front Cardiovasc Med 2021; 8:691907. [PMID: 34336954 PMCID: PMC8316592 DOI: 10.3389/fcvm.2021.691907] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Sodium–glucose co-transporter 2 (SGLT2) inhibitors are an emerging class of glucose-lowering drugs that have become increasingly relevant for the treatment and prevention of heart failure (HF). Therefore, we aimed to investigate various SGLT2 inhibitors in patients with established HF at baseline and focused on the different types of HF. Methods: An extensive search of PubMed and Web of Science until January 2021 was done. Two reviewers, independently and in duplicate, applied the selection criteria. This meta-analysis was conducted according to the PRISMA guidelines. Data were pooled using a random-effects model. Randomized controlled trials (RCTs) of SGLT2 inhibitors vs. a comparator in patients with HF reporting clinical outcomes were included. The primary efficacy outcome was the composite of hospitalization for HF (HHF) or cardiovascular (CV) mortality. All-cause mortality, CV mortality, and HHF were considered as secondary endpoints. Subgroup analyses involving the status of diabetes, type of HF, administered type of SGLT2 inhibitor, sex, age, body mass index (BMI), estimated glomerular filtration rate (eGFR), cause of HF, and concomitant medication were performed. Results: Seventeen RCTs, comprising a total of 20,749 participants, were included (n = 10,848 treated with SGLT2 inhibitors and n = 9,901 treated with a comparator). Treatment with SGLT2 inhibitors in a HF population was associated with a 27% relative risk reduction (RRR) of HHF or CV mortality [risk ratio (RR) = 0.73, 95% CI = 0.68–0.78], 32% RRR of HHF (RR = 0.68, 95% CI = 0.62–074), 18% RRR of CV mortality (RR = 0.82, 95% CI = 0.73–0.91), and 17% RRR of all-cause mortality (RR = 0.83, 95% CI = 0.75–0.91). The effect of SGLT2 inhibitors on the primary endpoint was consistent among the different gliflozines. The effect of SGLT2 inhibitors on the primary endpoint was independent of underlying diabetes mellitus, age, sex, BMI, renal function, and HF type. Conclusions: SGLT2 inhibitors are associated with improved CV outcomes in patients with HF.
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Affiliation(s)
- Gloria M Gager
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Dirk von Lewinski
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Warsaw, Poland
| | - Krzysztof Filipiak
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Warsaw, Poland
| | - Jolanta M Siller-Matula
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.,Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Warsaw, Poland
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15
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Chiang CJ, Chao YP, Ali A, Day CH, Ho TJ, Wang PN, Lin SC, Padma VV, Kuo WW, Huang CY. Probiotic Escherichia coli Nissle inhibits IL-6 and MAPK-mediated cardiac hypertrophy during STZ-induced diabetes in rats. Benef Microbes 2021; 12:283-293. [PMID: 34030609 DOI: 10.3920/bm2020.0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Escherichia coli Nissle (EcN), a probiotic bacterium protects against several disorders. Multiple reports have studied the pathways involved in cardiac hypertrophy. However, the effects of probiotic EcN against diabetes-induced cardiac hypertrophy remain to be understood. We administered five weeks old Wistar male (271±19.4 g body weight) streptozotocin-induced diabetic rats with 109 cfu of EcN via oral gavage every day for 24 days followed by subjecting the rats to echocardiography to analyse the cardiac parameters. Overexpressed interleukin (IL)-6 induced the MEK5/ERK5, JAK2/STAT3, and MAPK signalling cascades in streptozotocin-induced diabetic rats. Further, the upregulation of calcineurin, NFATc3, and p-GATA4 led to the elevation of hypertrophy markers, such as atrial and B-type natriuretic peptides. In contrast, diabetic rats supplemented with probiotic EcN exhibited significant downregulated IL-6. Moreover, the MEK5/ERK5 and JAK2/STAT3 cascades involved during eccentric hypertrophy and MAPK signalling, including phosphorylated MEK, ERK, JNK, and p-38, were significantly attenuated in diabetic rats after supplementation of EcN. Western blotting and immunofluorescence revealed the significant downregulation of NFATc3 and downstream mediators, thereby resulting in the impairment of cardiac hypertrophy. Taken together, the findings demonstrate that supplementing probiotic EcN has the potential to show cardioprotective effects by inhibiting diabetes-induced cardiomyopathies.
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Affiliation(s)
- C J Chiang
- Department of Medical Laboratory Science and Biotechnology, China Medical University, 91 Hsueh-Shih Rd., Taichung 40402, Taiwan
| | - Y P Chao
- Department of Chemical Engineering, Feng Chia University, No. 100 Wenhwa Rd., Seatwen, Taichung 40724, Taiwan
| | - A Ali
- Department of Biological Science and Technology, China Medical University, 91 Hsueh-Shih Rd., Taichung 40402, Taiwan
| | - C H Day
- Department of Nursing, MeiHo University, 23, Pingguang Rd., Neipu, Pingtung 912, Taiwan
| | - T J Ho
- Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, 707 Section 3 Chung-Yang Road, Hualien 97002, Taiwan.,Integration Center of Traditional Chinese and Modern Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan.,School of Post-Baccalaureate Chinese Medicine, College of Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien 97004, Taiwan
| | - P N Wang
- Department of Chemical Engineering, Feng Chia University, No. 100 Wenhwa Rd., Seatwen, Taichung 40724, Taiwan
| | - S C Lin
- Department of Medical Laboratory Science and Biotechnology, China Medical University, 91 Hsueh-Shih Rd., Taichung 40402, Taiwan
| | - V V Padma
- Department of Biotechnology, Bharathiar University, Coimbatore, India
| | - W W Kuo
- Department of Biological Science and Technology, China Medical University, 91 Hsueh-Shih Rd., Taichung 40402, Taiwan.,Ph.D. Program for Biotechnology Industry, China Medical University, Taichung 406, Taiwan
| | - C Y Huang
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, 91 Hsueh-Shih Rd., Taichung 40402, Taiwan.,Department of Biotechnology, Asia University, 500 Liufeng Rd., Wufeng, 41354 Taichung, Taiwan.,Center of General Education, Buddhist Tzu Chi Medical Foundation, Tzu Chi University of Science and Technology, Hualien 970, Taiwan
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16
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Diabetes mellitus: a primary metabolic disturbance. Metabolomics underlying vascular responses to stress and ischemia? Clin Sci (Lond) 2021; 135:589-591. [PMID: 33565585 DOI: 10.1042/cs20201299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022]
Abstract
Diabetes mellitus (DM) is a primary metabolic disorder and the impact of this entity on maladaptive tissue and organ responses may be mediated through alter metabolomic profile and signatures at steady state or at stress. To this point of view Beckman et al. (Clin. Sci. (Lond.) (2020) 134, 2369-2379), in a hypothesis-generated study, investigated how metabolomic profile is affected following branchial artery ischemia. Interestingly, they found that there is a dynamic and altered change of metabolites associated with energy substrate and with glycolysis/glyconeogenesis in patients with DM. This evidence may shed light on the impaired muscle tolerance in subjects with DM and on impaired vasoreactivity. However, these data lack the ability to be conclusive and further steps should be explored to understand how metabolomic profile is implicated in the response of muscle tissue to ischemia and to the clinical profile of subjects with DM.
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17
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Siasos G, Stampouloglou PK, Bletsa E, Paschou SA, Oikonomou E, Giannopoulos G, Deftereos S, Cleman MW, Tousoulis D. SGLT-2i and Cardiovascular Prognosis. Curr Pharm Des 2021; 26:3905-3907. [PMID: 33001001 DOI: 10.2174/138161282632200811172751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Gerasimos Siasos
- Unit of Heart and Diabetes, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota K Stampouloglou
- Unit of Heart and Diabetes, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evanthia Bletsa
- Unit of Heart and Diabetes, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Unit of Heart and Diabetes, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Oikonomou
- Unit of Heart and Diabetes, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Giannopoulos
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Spyridon Deftereos
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Michael W Cleman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Dimitrios Tousoulis
- Unit of Heart and Diabetes, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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18
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Siasos G. Diabetes and Cardiovascular Disease. Curr Pharm Des 2021; 26:5909-5910. [PMID: 33413054 DOI: 10.2174/138161282646201218090901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gerasimos Siasos
- 3rd Department of Cardiology, "Sotiria" Hospital University of Athens Medical School Athens, Greece
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19
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Lorbeer R, Rospleszcz S, Schlett CL, Rado SD, Thorand B, Meisinger C, Rathmann W, Heier M, Vasan RS, Bamberg F, Peters A, Lieb W. Association of antecedent cardiovascular risk factor levels and trajectories with cardiovascular magnetic resonance-derived cardiac function and structure. J Cardiovasc Magn Reson 2021; 23:2. [PMID: 33390171 PMCID: PMC7780638 DOI: 10.1186/s12968-020-00698-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/09/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The association of longitudinal trajectories of cardiovascular risk factors with cardiovascular magnetic resonance (CMR)-measures of cardiac structure and function in the community is not well known. Therefore we aimed to relate risk factor levels from different examination cycles to CMR-measures of the left ventricle (LV) and right ventricle in a population-based cohort. METHODS We assessed conventional cardiovascular disease risk factors in 349 participants (143 women; aged 25-59 years) at three examination cycles (Exam 1 [baseline], at Exam 2 [7-years follow-up] and at Exam 3 [14-years follow-up]) of the KORA S4 cohort and related single-point measurements of individual risk factors and longitudinal trajectories of these risk factors to various CMR-measures obtained at Exam 3. RESULTS High levels of diastolic blood pressure, waist circumference, and LDL-cholesterol at the individual exams were associated with worse cardiac function and structure. Trajectory clusters representing higher levels of the individual risk factors were associated with worse cardiac function and structure compared to low risk trajectory clusters of individual risk factors. Multivariable (combining different risk factors) trajectory clusters were associated with different cardiac parameters in a graded fashion (e.g. decrease of LV stroke volume for middle risk cluster β = - 4.91 ml/m2, 95% CI - 7.89; - 1.94, p < 0.01 and high risk cluster β = - 7.00 ml/m2, 95% CI - 10.73; - 3.28, p < 0.001 compared to the low risk cluster). The multivariable longitudinal trajectory clusters added significantly to explain variation in CMR traits beyond the multivariable risk profile obtained at Exam 3. CONCLUSIONS Cardiovascular disease risk factor levels, measured over a time period of 14 years, were associated with CMR-derived measures of cardiac structure and function. Longitudinal multivariable trajectory clusters explained a greater proportion of the inter-individual variation in cardiac traits than multiple risk factor assessed contemporaneous with the CMR exam.
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Affiliation(s)
- Roberto Lorbeer
- Department of Radiology, University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany.
- German Center for Cardiovascular Disease Research (DZHK E.V.), Munich, Germany.
| | - Susanne Rospleszcz
- German Center for Cardiovascular Disease Research (DZHK E.V.), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Epidemiology, Institute of Medical Information Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center, University Freiburg, Freiburg, Germany
| | - Sophia D Rado
- Department of Diagnostic and Interventional Radiology, Eberhard Karl University Tübingen, Tübingen, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
| | - Christa Meisinger
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Epidemiology, LMU Munich, UNIKA-T Augsburg, Augsburg, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany
- Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
| | - Ramachandran S Vasan
- Preventive Medicine and Epidemiology Section, Boston University School of Medicine and Framingham Heart Study, Framingham, MA, USA
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, University Freiburg, Freiburg, Germany
| | - Annette Peters
- German Center for Cardiovascular Disease Research (DZHK E.V.), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Epidemiology, Institute of Medical Information Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
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20
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Predictive Factors on the Incidence of Heart Failure in Patients with Ischemic Heart Disease: Using a 10-Year Population-Based Korea National Health Insurance Cohort Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228670. [PMID: 33266413 PMCID: PMC7700236 DOI: 10.3390/ijerph17228670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022]
Abstract
Early risk stratification and preventative strategies are required in patients with ischemic heart disease (IHD) to prevent heart failure (HF). We aimed to investigate the rate of progression to HF and to investigate the factors predicting the development of HF in a population with IHD for 10 years. A descriptive study was conducted using Korea National Health Insurance Service-National Sample Cohort (NHI-NSC) data (2005-2015). Among the patients diagnosed with IHD for the first time in 2005-2006, 2271 men and 2037 women who responded to the health check-up survey were finally selected. Cox Proportional Hazard regression analyses and the Kaplan-Meier survival analysis were used. HF incidence rates were 5.1% in men and 8.0% in women. The mean duration of transition to HF was 4.85 ± 2.73 years in men and 4.73 ± 2.73 years in women. The non-incidence rate of HF was higher in men than in women (Log-rank test, p = 0.0003). Bivariate analyses showed that older age, prevalence of hypertension and diabetes, less alcohol, and lower physical exercise were associated with the incidence of HF in both men and women. Multivariate analyses found that HF incidence in aged subjects ≥70 years was 1.46 times higher in men and 1.44 times higher in women compared to those in their 30 s (p < 0.001). Prevalence of hypertension reduced the incidence of HF by 0.78 and 0.87 for men and women, respectively. The prevalence of diabetes increased 1.23 times only in men. These findings suggest that special attention such as periodic counseling and education is needed to prevent progression to HF in elderly and diabetic patients during follow-up after IHD.
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Siasos G, Bletsa E, Stampouloglou PK, Paschou SA, Oikonomou E, Tsigkou V, Antonopoulos AS, Vavuranakis M, Tousoulis D. Novel Antidiabetic Agents: Cardiovascular and Safety Outcomes. Curr Pharm Des 2020; 26:5911-5932. [PMID: 33167826 DOI: 10.2174/1381612826666201109110107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Concerns of elevated cardiovascular risk with some anti-diabetic medications warranted trials on the cardiovascular outcome to demonstrate cardiovascular safety of newly marketed anti-diabetic drugs. Although these trials were initially designed to evaluate safety, some of these demonstrated significant cardiovascular benefits. PURPOSE OF REVIEW We reviewed the cardiovascular and safety outcomes of novel antidiabetic agents in patients with type 2 diabetes and established cardiovascular disease or at high risk of it. We included the outcomes of safety trials, randomized controlled trials, meta-analysis, large cohort studies, and real-world data, which highlighted the cardiovascular profile of DPP-4is, GLP-1RAs and SGLT-2is. CONCLUSION Although DPP-4is demonstrated non-inferiority to placebo, gaining cardiovascular safety, as well market authorization, SGLT-2is and most of the GLP-1RAs have shown impressive cardiovascular benefits in patients with T2D and established CVD or at high risk of it. These favorable effects of novel antidiabetic agents on cardiovascular parameters provide novel therapeutic approaches in medical management, risk stratification and prevention.
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Affiliation(s)
- Gerasimos Siasos
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evanthia Bletsa
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota K Stampouloglou
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Tsigkou
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios S Antonopoulos
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Manolis Vavuranakis
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Gatzoulis KA, Tsiachris D, Arsenos P, Antoniou CK, Dilaveris P, Sideris S, Kanoupakis E, Simantirakis E, Korantzopoulos P, Goudevenos I, Flevari P, Iliodromitis E, Sideris A, Vassilikos V, Fragakis N, Trachanas K, Vernardos M, Konstantinou I, Tsimos K, Xenogiannis I, Vlachos K, Saplaouras A, Triantafyllou K, Kallikazaros I, Tousoulis D. Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: the PRESERVE EF study. Eur Heart J 2020; 40:2940-2949. [PMID: 31049557 PMCID: PMC6748724 DOI: 10.1093/eurheartj/ehz260] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/26/2018] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Aims Sudden cardiac death (SCD) annual incidence is 0.6–1% in post-myocardial infarction (MI) patients with left ventricular ejection fraction (LVEF)≥40%. No recommendations for implantable cardioverter-defibrillator (ICD) use exist in this population. Methods and results We introduced a combined non-invasive/invasive risk stratification approach in post-MI ischaemia-free patients, with LVEF ≥ 40%, in a multicentre, prospective, observational cohort study. Patients with at least one positive electrocardiographic non-invasive risk factor (NIRF): premature ventricular complexes, non-sustained ventricular tachycardia, late potentials, prolonged QTc, increased T-wave alternans, reduced heart rate variability, abnormal deceleration capacity with abnormal turbulence, were referred for programmed ventricular stimulation (PVS), with ICDs offered to those inducible. The primary endpoint was the occurrence of a major arrhythmic event (MAE), namely sustained ventricular tachycardia/fibrillation, appropriate ICD activation or SCD. We screened and included 575 consecutive patients (mean age 57 years, LVEF 50.8%). Of them, 204 (35.5%) had at least one positive NIRF. Forty-one of 152 patients undergoing PVS (27–7.1% of total sample) were inducible. Thirty-seven (90.2%) of them received an ICD. Mean follow-up was 32 months and no SCDs were observed, while 9 ICDs (1.57% of total screened population) were appropriately activated. None patient without NIRFs or with NIRFs but negative PVS met the primary endpoint. The algorithm yielded the following: sensitivity 100%, specificity 93.8%, positive predictive value 22%, and negative predictive value 100%. Conclusion The two-step approach of the PRESERVE EF study detects a subpopulation of post-MI patients with preserved LVEF at risk for MAEs that can be effectively addressed with an ICD. Clinicaltrials.gov identifier NCT02124018 ![]()
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Affiliation(s)
- Konstantinos A Gatzoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Petros Arsenos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Skevos Sideris
- State Department of Cardiology, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Emmanuel Kanoupakis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Emmanouil Simantirakis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Panagiotis Korantzopoulos
- First Cardiology Division, University Hospital of Ioannina, University of Ioannina, Stavros Niarchos avenue, Ioannina, Epirus, Greece
| | - Ioannis Goudevenos
- First Cardiology Division, University Hospital of Ioannina, University of Ioannina, Stavros Niarchos avenue, Ioannina, Epirus, Greece
| | - Panagiota Flevari
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini street, Chaidari, Attica, Greece
| | - Efstathios Iliodromitis
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini street, Chaidari, Attica, Greece
| | - Antonios Sideris
- Second State Cardiology Department, Evangelismos Hospital, 45-47 Ipsilantou street, Athens, Attica, Greece
| | - Vassilios Vassilikos
- Third Cardiology Department, Aristotle University Medical School, Hippokrateion Hospital, 49 Konstantinoupoleos street, Thessaloniki, Macedonia, Greece
| | - Nikolaos Fragakis
- Third Cardiology Department, Aristotle University Medical School, Hippokrateion Hospital, 49 Konstantinoupoleos street, Thessaloniki, Macedonia, Greece
| | - Konstantinos Trachanas
- State Department of Cardiology, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Michail Vernardos
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Ioannis Konstantinou
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Konstantinos Tsimos
- First Cardiology Division, University Hospital of Ioannina, University of Ioannina, Stavros Niarchos avenue, Ioannina, Epirus, Greece
| | - Iosif Xenogiannis
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini street, Chaidari, Attica, Greece
| | - Konstantinos Vlachos
- Second State Cardiology Department, Evangelismos Hospital, 45-47 Ipsilantou street, Athens, Attica, Greece
| | - Athanasios Saplaouras
- Second State Cardiology Department, Evangelismos Hospital, 45-47 Ipsilantou street, Athens, Attica, Greece
| | - Konstantinos Triantafyllou
- Third Cardiology Department, Aristotle University Medical School, Hippokrateion Hospital, 49 Konstantinoupoleos street, Thessaloniki, Macedonia, Greece
| | - Ioannis Kallikazaros
- State Department of Cardiology, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
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23
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Siasos G, Skotsimara G, Oikonomou E, Sagris M, Vasiliki-Chara M, Bletsa E, Stampouloglou P, Theofilis P, Charalampous G, Tousoulis D. Antithrombotic Treatment in Diabetes Mellitus: A Review of the Literature about Antiplatelet and Anticoagulation Strategies Used for Diabetic Patients in Primary and Secondary Prevention. Curr Pharm Des 2020; 26:2780-2788. [PMID: 32303164 DOI: 10.2174/1381612826666200417145605] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023]
Abstract
Background:
Diabetes mellitus (DM) is on the rise globally. Its prevalence has nearly doubled
during the last two decades and it is estimated to affect 8.8% of the global population.
Cardiovascular disease (CVD) is the leading cause of death in diabetic population and despite
modern anti-inflammatory and cardioprotective therapeutic strategies diabetic patients have at
least a twice fold risk of cardiovascular events. Prothrombotic state in DM is associated with
multiple determinants such as platelet alterations, oxidative stress, endothelial changes,
circulating mediators. Thus, proper antithrombotic strategies to reduce the risk of CVD in this
population is critical.
Methods:
This article reviews the current antiplatelet and anticoagulant
agents in the aspect of primary and secondary prevention of CVD in the diabetic population.
Results:
The use of aspirin may be considered only at high-risk patients in the absence of
contraindications. Cangrelor was not inferior to clopidogrel in preventing the composite outcome
of CV death, myocardial infraction and revascularization without increasing major bleeding.
Triple therapy in the subpopulation with DM significantly reduced the composite primary
outcome of CV death, myocardial infraction or repeat target lesion revascularization. That was
not the case for stent thrombosis, which was similar in both groups. Importantly, triple therapy
did not result in increased bleeding complications, which were similar in both groups. However,
cilostazol is linked to various adverse effects (e.g., headache, palpitations, and gastrointestinal
disturbances) that drive many patients to withdrawal.
Conclusion:
In conclusion, DM is a
rapidly growing disease that increases the risk of CVD, AF, and CV mortality. Proper
antithrombotic strategies to reduce CVD risk in DM is a necessity. Also, new antithrombotic
treatments and combination therapies may play a critical role to overcome antiplatelet resistance
in DM patients and reduce morbidity and mortality attributed to CVD.
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Affiliation(s)
- Gerasimos Siasos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Georgia Skotsimara
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Marios Sagris
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Mystakidi Vasiliki-Chara
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Evanthia Bletsa
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Panagiota Stampouloglou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Panagiotis Theofilis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Georgios Charalampous
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens, Greece
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Berra C, Manfrini R, Regazzoli D, Radaelli MG, Disoteo O, Sommese C, Fiorina P, Ambrosio G, Folli F. Blood pressure control in type 2 diabetes mellitus with arterial hypertension. The important ancillary role of SGLT2-inhibitors and GLP1-receptor agonists. Pharmacol Res 2020; 160:105052. [PMID: 32650058 DOI: 10.1016/j.phrs.2020.105052] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/09/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes mellitus and arterial hypertension are major cardiovascular risks factors which shares metabolic and haemodynamic abnormalities as well as pathophysiological mechanisms. The simultaneous presence of diabetes and arterial hypertension increases the risk of left ventricular hypertrophy, congestive heart failure, and stroke, as compared to either condition alone. A number of guidelines recommend lifestyle measures such as salt restriction, weight reduction and ideal body weight mainteinance, regular physical activity and smoking cessation, together with moderation of alcohol consumption and high intake of vegetables and fruits, as the basis for reduction of blood pressure and prevention of CV diseases. Despite the availability of multiple drugs effective for hypertension, BP targets are reached in only 50 % of patients, with even fewer individuals with T2DM-achieving goals. It is established that new emerging classes of type 2 diabetes mellitus treatment, SGLT2 inhibitors and GLP1-receptor agonists, are efficacious on glucose control, and safe in reducing HbA1c significantly, without increasing hypoglycemic episodes. Furthermore, in recent years, many CVOT trials have demonstrated, using GLP1-RA or SGLT2-inihibitors compared to placebo (in combination with the usual diabetes medications) important benefits on reducing MACE (cardio-cerebral vascular events) in the diabetic population. In this hypothesis-driven review, we have examined the anti-hypertensive effects of these novel molecules of the two different classes, in the diabetic population, and suggest that they could have an interesting ancillary role in controlling blood pressure in type 2 diabetic patients.
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Affiliation(s)
- C Berra
- Department of Endocrine and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy.
| | - R Manfrini
- Departmental Unit of Diabetes and Metabolic Disease, ASST Santi Paolo e Carlo, Milan, Italy
| | - D Regazzoli
- Department of Cardiovascular Disease, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - M G Radaelli
- Department of Endocrine and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - O Disoteo
- Endocrinology and Diabetology Service, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Sommese
- IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - P Fiorina
- University of Milano, Milan, Italy; TID International Center, Invernizzi Research Center, Milan, Italy; Endocrinology and Diabetology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - G Ambrosio
- University of Perugia School of Medicine, Perugia, Italy
| | - F Folli
- Departmental Unit of Diabetes and Metabolic Disease, ASST Santi Paolo e Carlo, Milan, Italy; University of Milano, Milan, Italy; Endocrinology and Metabolism, Department of Health Science University of Milano, Italy
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25
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Siasos G, Bletsa E, Stampouloglou PK, Oikonomou E, Tsigkou V, Paschou SA, Vlasis K, Marinos G, Vavuranakis M, Stefanadis C, Tousoulis D. MicroRNAs in cardiovascular disease. Hellenic J Cardiol 2020; 61:165-173. [PMID: 32305497 DOI: 10.1016/j.hjc.2020.03.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/08/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) remains the predominant cause of human morbidity and mortality in developed countries. Currently, microRNAs have been investigated in many diseases as well-promising biomarkers for diagnosis, prognosis, and disease monitoring. Plenty studies have been designed so as to elucidate the properties of microRNAs in the classification and risk stratification of patients with CVD and also to evaluate their potentials in individualized management and guide treatment decisions. Therefore, in this review article, we aimed to present the most recent data concerning the role of microRNAs as potential novel biomarkers for cardiovascular disease.
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Affiliation(s)
- Gerasimos Siasos
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Evanthia Bletsa
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagiota K Stampouloglou
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Oikonomou
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasiliki Tsigkou
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Stavroula A Paschou
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Konstantinos Vlasis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Marinos
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Manolis Vavuranakis
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christodoulos Stefanadis
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitris Tousoulis
- Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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26
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Cardiometabolic medicine: time to recognize a new clinical specialty? Cardiovasc Endocrinol Metab 2019; 8:47-48. [PMID: 31588426 DOI: 10.1097/xce.0000000000000173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 01/09/2023]
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27
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Philip L, Poole R. Double trouble: managing diabetic emergencies in patients with heart failure. PRACTICAL DIABETES 2018. [DOI: 10.1002/pdi.2181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Ruth Poole
- Poole Hospital NHS Trust; Poole, Dorset UK
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28
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Kaur P, Saxena N, You AX, Wong RCC, Lim CP, Loh SY, George PP. Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore. BMJ Open 2018; 8:e021291. [PMID: 29780030 PMCID: PMC5961600 DOI: 10.1136/bmjopen-2017-021291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Multimorbidity in patients with heart failure (HF) results in poor prognosis and is an increasing public health concern. We aim to examine the effect of multimorbidity focusing on type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) on all-cause and cardiovascular disease (CVD)-specific mortality among patients diagnosed with HF in Singapore. DESIGN Retrospective cohort study. SETTING Primary and tertiary care in three (out of six) Regional Health Systems in Singapore. PARTICIPANTS Patients diagnosed with HF between 2003 and 2016 from three restructured hospitals and nine primary care polyclinics were included in this retrospective cohort study. PRIMARY OUTCOMES All-cause mortality and CVD-specific mortality. RESULTS A total of 34 460 patients diagnosed with HF from 2003 to 2016 were included in this study and were followed up until 31 December 2016. The median follow-up time was 2.1 years. Comorbidities prior to HF diagnosis were considered. Patients were categorised as (1) HF only, (2) T2DM+HF, (3) CKD+HF and (4) T2DM+CKD+HF. Cox regression model was used to determine the effect of multimorbidity on (1) all-cause mortality and (2) CVD-specific mortality. Adjusting for demographics, other comorbidities, baseline treatment and duration of T2DM prior to HF diagnosis, 'T2DM+CKD+HF' patients had a 56% higher risk of all-cause mortality (HR: 1.56, 95% CI 1.48 to 1.63) and a 44% higher risk of CVD-specific mortality (HR: 1.44, 95% CI 1.32 to 1.56) compared with patients diagnosed with HF only. CONCLUSION All-cause and CVD-specific mortality risks increased with increasing multimorbidity. This study highlights the need for a new model of care that focuses on holistic patient management rather than disease management alone to improve survival among patients with HF with multimorbidity.
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Affiliation(s)
- Palvinder Kaur
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Nakul Saxena
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Alex Xiaobin You
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Raymond C C Wong
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Choon Pin Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Seet Yoong Loh
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
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