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Gadager BB, Tang LH, Doherty P, Svendsen ML, Sibilitz KL, Harrison A, Maribo T. Are cardiac rehabilitation pathways influenced by diabetes: A cohort study. Int J Cardiol 2024; 411:132275. [PMID: 38880427 DOI: 10.1016/j.ijcard.2024.132275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is recommended following acute coronary syndrome (ACS). Diabetes is a common long-term condition associated with ACS, and the inclusion of these patients in CR has been less studied. This study examines the referral, uptake, and completion rates in the CR pathway for ACS patients with and without diabetes to identify potential barriers in the CR pathway. METHODS The study included patients aged 18 or above who were discharged after a diagnosis of ACS in the Central Denmark Region between 1 September 2017 and 31 August 2018. Diabetes information was obtained from three sources. Logistic regression models were used to examine the associations between having diabetes and the three outcomes: non-referral, non-uptake and non-completion. Results were reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS A total of 2447 patients were eligible for the study, of which 457 (18.7%) had diabetes. Only non-uptake was found to be significantly associated with diabetes after adjustment for prespecified variables (OR = 1.38, 95% CI 1.01-1.90). Associations for non-referral (OR = 1.11, 95% CI 0.87-1.41) and non-completion (OR = 1.06, 95 %CI 0.73-1.53) were not found to be statistically significant between ACS patients with diabetes and those without diabetes. CONCLUSION This study highlights a significant disparity in the uptake of CR between patients with and without diabetes following ACS, demonstrating that patients with diabetes require early promotion and increased assistance to enrol in CR.
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Affiliation(s)
- Birgitte Bitsch Gadager
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Lars Hermann Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark, Denmark
| | | | | | | | | | - Thomas Maribo
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark.
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2
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Zhang Q, Zhao X, Sun M, Dong D. Novel insights into transfer RNA-derived small RNA (tsRNA) in cardio-metabolic diseases. Life Sci 2024; 341:122475. [PMID: 38309576 DOI: 10.1016/j.lfs.2024.122475] [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: 10/13/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
Cardio-metabolic diseases, including a cluster of metabolic disorders and their secondary affections on cardiovascular physiology, are gradually brought to the forefront by researchers due to their high prevalence and mortality, as well as an unidentified pathogenesis. tRNA-derived small RNAs (tsRNAs), cleaved by several specific enzymes and once considered as some "metabolic junks" in the past, have been proved to possess numerous functions in human bodies. More interestingly, such a potential also seems to influence the progression of cardio-metabolic diseases to some extent. In this review, the biogenesis, classification and mechanisms of tsRNAs will be discussed based on some latest studies, and their relations with several cardio-metabolic diseases will be highlighted in sequence. Lastly, some future prospects, such as their clinical applications as biomarkers and therapeutic targets will also be mentioned, in order to provide researchers with a comprehensive understanding of the research status of tsRNAs as well as its association with cardio-metabolic diseases, thus presenting as a beacon to indicate directions for the next stage of study.
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Affiliation(s)
- Qingya Zhang
- Innovation Institute, China Medical University, Shenyang 110122, Liaoning, China
| | - Xiaopeng Zhao
- College of Exercise and Health, Shenyang Sport University, Shenyang 110102, Liaoning, China
| | - Mingli Sun
- College of Exercise and Health, Shenyang Sport University, Shenyang 110102, Liaoning, China
| | - Dan Dong
- College of Basic Medical Science, China Medical University, Shenyang 110122, Liaoning, China.
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3
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Ahmad A, Lim LL, Morieri ML, Tam CHT, Cheng F, Chikowore T, Dudenhöffer-Pfeifer M, Fitipaldi H, Huang C, Kanbour S, Sarkar S, Koivula RW, Motala AA, Tye SC, Yu G, Zhang Y, Provenzano M, Sherifali D, de Souza RJ, Tobias DK, Gomez MF, Ma RCW, Mathioudakis N. Precision prognostics for cardiovascular disease in Type 2 diabetes: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2024; 4:11. [PMID: 38253823 PMCID: PMC10803333 DOI: 10.1038/s43856-023-00429-z] [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: 05/12/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with Type 2 diabetes (T2D). METHODS We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that may improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies. RESULTS Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination, with lower performance in populations different from the original development cohort. CONCLUSIONS Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.
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Affiliation(s)
- Abrar Ahmad
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Asia Diabetes Foundation, Hong Kong SAR, China
| | - Mario Luca Morieri
- Metabolic Disease Unit, University Hospital of Padova, Padova, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Claudia Ha-Ting Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Feifei Cheng
- Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Tinashe Chikowore
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hugo Fitipaldi
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Chuiguo Huang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Sudipa Sarkar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Wilhelm Koivula
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sok Cin Tye
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
- Sections on Genetics and Epidemiology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gechang Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yingchai Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michele Provenzano
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Diana Sherifali
- Heather M. Arthur Population Health Research Institute, McMaster University, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | | | - Maria F Gomez
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden.
- Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Nestoras Mathioudakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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4
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Ahmad A, Lim LL, Morieri ML, Tam CHT, Cheng F, Chikowore T, Dudenhöffer-Pfeifer M, Fitipaldi H, Huang C, Kanbour S, Sarkar S, Koivula RW, Motala AA, Tye SC, Yu G, Zhang Y, Provenzano M, Sherifali D, de Souza R, Tobias DK, Gomez MF, Ma RCW, Mathioudakis NN. Precision Prognostics for Cardiovascular Disease in Type 2 Diabetes: A Systematic Review and Meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.26.23289177. [PMID: 37162891 PMCID: PMC10168509 DOI: 10.1101/2023.04.26.23289177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with type 2 diabetes (T2D). Methods We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that may improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies. Results Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination, with lower performance in populations different from the original development cohort. Conclusions Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.
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5
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Munsch G, Goumidi L, van Hylckama Vlieg A, Ibrahim-Kosta M, Bruzelius M, Deleuze JF, Rosendaal FR, Jacqmin-Gadda H, Morange PE, Trégouët DA. Association of ABO blood groups with venous thrombosis recurrence in middle-aged patients: insights from a weighted Cox analysis dedicated to ambispective design. BMC Med Res Methodol 2023; 23:99. [PMID: 37087423 PMCID: PMC10122291 DOI: 10.1186/s12874-023-01915-7] [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: 04/11/2022] [Accepted: 04/04/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND In studies of time-to-events, it is common to collect information about events that occurred before the inclusion in a prospective cohort. When the studied risk factors are independent of time, including both pre- and post-inclusion events in the analyses, generally referred to as relying on an ambispective design, increases the statistical power but may lead to a selection bias. In the field of venous thromboembolism (VT), ABO blood groups have been the subject of extensive research due to their substantial effect on VT risk. However, few studies have investigated their effect on the risk of VT recurrence. Motivated by the study of the association of genetically determined ABO blood groups with VT recurrence, we propose a methodology to include pre-inclusion events in the analysis of ambispective studies while avoiding the selection bias due to mortality. METHODS This work relies on two independent cohorts of VT patients, the French MARTHA study built on an ambispective design and the Dutch MEGA study built on a standard prospective design. For the analysis of the MARTHA study, a weighted Cox model was developed where weights were defined by the inverse of the survival probability at the time of data collection about the events. Thanks to the collection of information on the vital status of patients, we could estimate the survival probabilities using a delayed-entry Cox model on the death risk. Finally, results obtained in both studies were then meta-analysed. RESULTS In the combined sample totalling 2,752 patients including 993 recurrences, the A1 blood group has an increased risk (Hazard Ratio (HR) of 1.18, p = 4.2 × 10-3) compared with the O1 group, homogeneously in MARTHA and in MEGA. The same trend (HR = 1.19, p = 0.06) was observed for the less frequent A2 group. CONCLUSION The proposed methodology increases the power of studies relying on an ambispective design which is frequent in epidemiologic studies about recurrent events. This approach allowed to clarify the association of ABO blood groups with the risk of VT recurrence. Besides, this methodology has an immediate field of application in the context of genome wide association studies.
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Affiliation(s)
- Gaëlle Munsch
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, 33000, Bordeaux, France
| | - Louisa Goumidi
- Cardiovascular and Nutrition Research Center (C2VN), INSERM, INRAE, Aix-Marseille University, Marseille, France
| | | | - Manal Ibrahim-Kosta
- Cardiovascular and Nutrition Research Center (C2VN), INSERM, INRAE, Aix-Marseille University, Marseille, France
| | - Maria Bruzelius
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Jean-François Deleuze
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
- Centre d'Etude du Polymorphisme Humain, Fondation Jean Dausset, Paris, France
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Hélène Jacqmin-Gadda
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, 33000, Bordeaux, France.
| | - Pierre-Emmanuel Morange
- Cardiovascular and Nutrition Research Center (C2VN), INSERM, INRAE, Aix-Marseille University, Marseille, France
| | - David-Alexandre Trégouët
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, 33000, Bordeaux, France
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6
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Desai RJ, Glynn RJ, Everett BM, Schneeweiss S, Wexler DJ, Bessette LG, Déruaz-Luyet A, Vedin O, Brodovicz K, Patorno E. Comparative effectiveness of Empagliflozin in reducing the burden of recurrent cardiovascular hospitalizations among older adults with diabetes in routine clinical care. Am Heart J 2022; 254:203-215. [PMID: 36150454 DOI: 10.1016/j.ahj.2022.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 07/21/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The effect of sodium glucose cotransporter 2 inhibitors (SGLT2i) on the total (first and recurrent) burden of cardiovascular (CV) hospitalizations, including hospitalization for heart failure, myocardial infarction, and stroke, is poorly understood. OBJECTIVE To assess the effect of empagliflozin, an SGLT2i, on total CV hospitalizations among older adults with T2D. METHODS Using data from Medicare fee-for-service (08/2014-09/2017), we identified 1:1 propensity score-matched cohorts of patients with T2D initiating empagliflozin versus sitagliptin or empagliflozin versus glucagon-like peptide-1 receptor agonists (GLP-1RA), balancing >140 baseline covariates. We compared the risk of first and recurrent hospitalizations with any CV condition as the primary discharge diagnosis (ICD-9: 390-459; ICD-10: I00-I99), hospitalizations for heart failure (HHF), and myocardial infarctions (MI) or stroke. We estimated treatment effects based on the Ghosh-Lin semiparametric model for recurrent events as primary and joint frailty model as secondary analysis. RESULTS We included 11,429 matched-pairs of empagliflozin and sitagliptin initiators and 17,502 matched-pairs of empagliflozin and GLP1-RA initiators with an average age of 72 years. Empagliflozin was associated with a reduced risk of total CV hospitalizations (0.80 [0.69-0.93] vs sitagliptin; 0.88 [0.77-1.00] vs GLP-1RA) and total HHF (0.70 [0.51-0.98] vs sitagliptin; 0.76 [0.56-1.03] vs GLP1-RA) over a mean follow up of 6.3 months. No differences between treatments were observed for MI or stroke. Results were consistent for joint frailty models. CONCLUSION Empagliflozin, compared to sitagliptin or to a lesser extent GLP1-RA, was associated with a reduction in the burden of total CV hospitalizations and HHF in older patients with T2D.
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Affiliation(s)
- Rishi J Desai
- Division of Pharmacoepidemiology, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.
| | - Robert J Glynn
- Division of Pharmacoepidemiology, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Brendan M Everett
- Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Deborah J Wexler
- Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, MA
| | - Lily G Bessette
- Division of Pharmacoepidemiology, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Anouk Déruaz-Luyet
- Boehringer Ingelheim, Ingelheim (Germany), Stockholm, (Sweden), and Ridgefield, CT
| | - Ola Vedin
- Boehringer Ingelheim, Ingelheim (Germany), Stockholm, (Sweden), and Ridgefield, CT
| | - Kimberly Brodovicz
- Boehringer Ingelheim, Ingelheim (Germany), Stockholm, (Sweden), and Ridgefield, CT
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
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7
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Li J, Arnott C, Heerspink HJL, MBiostat QL, Cannon CP, Wheeler DC, Charytan DM, Barraclough J, Figtree GA, Agarwal R, Bakris G, de Zeeuw D, Greene T, Levin A, Pollock C, Zhang H, Zinman B, Mahaffey KW, Perkovic V, Neal B, Jardine MJ. Effect of Canagliflozin on Total Cardiovascular Burden in Patients With Diabetes and Chronic Kidney Disease: A Post Hoc Analysis From the CREDENCE Trial. J Am Heart Assoc 2022; 11:e025045. [PMID: 35929472 PMCID: PMC9496296 DOI: 10.1161/jaha.121.025045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The sodium‐glucose cotransporter 2 inhibitor canagliflozin reduced the risk of first cardiovascular composite events in the CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) trial. In this post hoc analysis, we evaluated the effect of canagliflozin on total (first and recurrent) cardiovascular events. Methods and Results The CREDENCE trial compared canagliflozin or matching placebo in 4401 patients with type 2 diabetes, albuminuria, and estimated glomerular filtration rate of 30 to <90 mL/min per 1.73 m2, over a median of 2.6 years. The primary outcome was analyzed as a composite of any cardiovascular event including myocardial infarction, stroke, hospitalization for heart failure, hospitalization for unstable angina, and cardiovascular death. Negative binomial regression models were used to assess the effect of canagliflozin on the net burden of cardiovascular events. During the trial, 634 patients had 883 cardiovascular events, of whom 472 (74%) had just 1 cardiovascular event and 162 (26%) had multiple cardiovascular events. Canagliflozin reduced first cardiovascular events by 26% (hazard ratio, 0.74 [95% CI, 0.63–0.86]; P<0.001) and total cardiovascular events by 29% (incidence rate ratio, 0.71 [95% CI, 0.59–0.86]; P<0.001). The absolute risk difference per 1000 patients treated over 2.5 years was −44 (95% CI, −67 to −21) first cardiovascular events and −73 (95% CI, −114 to −33) total events. Conclusions Canagliflozin reduced cardiovascular events, with a larger absolute benefit for total cardiovascular than first cardiovascular events. These findings provide further support for the benefit of continuing canagliflozin therapy after an initial event to prevent recurrent cardiovascular events. Registration Information URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02065791.
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Affiliation(s)
- Jing‐Wei Li
- The George Institute for Global HealthUNSW SydneySydneyAustralia
- Department of Cardiology, Xinqiao HospitalArmy Military Medical UniversityChongqingChina
| | - Clare Arnott
- The George Institute for Global HealthUNSW SydneySydneyAustralia
- Department of Cardiology, Royal Prince Alfred HospitalSydneyAustralia
- Sydney Medical SchoolThe University of SydneySydneyNew South Wales
| | - Hiddo J. L. Heerspink
- The George Institute for Global HealthUNSW SydneySydneyAustralia
- Department Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical CenterGroningenThe Netherlands
| | | | - Christopher P. Cannon
- Cardiovascular DivisionBrigham & Women’s Hospital and Baim Institute for Clinical ResearchBostonMA
| | - David C. Wheeler
- The George Institute for Global HealthUNSW SydneySydneyAustralia
- Department of Renal MedicineUCL Medical SchoolLondonUK
| | - David M. Charytan
- Nephrology DivisionNYU School of Medicine and NYU Langone Medical CenterNew YorkNY
- Baim Institute for Clinical ResearchBostonMA
| | - Jennifer Barraclough
- The George Institute for Global HealthUNSW SydneySydneyAustralia
- Department of Cardiology, Royal Prince Alfred HospitalSydneyAustralia
| | - Gemma A. Figtree
- The George Institute for Global HealthUNSW SydneySydneyAustralia
- Sydney Medical SchoolThe University of SydneySydneyNew South Wales
- Kolling InstituteRoyal North Shore Hospital and University of SydneySydneyAustralia
| | - Rajiv Agarwal
- Indiana University School of Medicine and VA Medical CenterIndianapolisIN
| | - George Bakris
- Department of MedicineUniversity of Chicago MedicineChicagoIL
| | - Dick de Zeeuw
- Department Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical CenterGroningenThe Netherlands
| | - Tom Greene
- Division of Biostatistics, Department of Population Health SciencesUniversity of UtahSalt Lake CityUT
| | - Adeera Levin
- Division of NephrologyUniversity of British ColumbiaVancouverBC
| | - Carol Pollock
- Kolling InstituteRoyal North Shore Hospital and University of SydneySydneyAustralia
| | - Hong Zhang
- Renal Division of Peking University First HospitalBeijingChina
| | - Bernard Zinman
- Lunenfeld‐Tanenbaum Research Institute, Mt Sinai HospitalUniversity of TorontoTorontoON
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research, Department of MedicineStanford University School of MedicineStanfordCA
| | - Vlado Perkovic
- The George Institute for Global HealthUNSW SydneySydneyAustralia
- The Royal North Shore HospitalSydneyAustralia
| | - Bruce Neal
- The George Institute for Global HealthUNSW SydneySydneyAustralia
- The Charles Perkins CentreUniversity of SydneySydneyNew South Wales
- Imperial College LondonLondonUK
| | - Meg J. Jardine
- The George Institute for Global HealthUNSW SydneySydneyAustralia
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNew South Wales
- Concord Repatriation General HospitalSydneyNew South Wales
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8
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Liu L, Shi Z, Ji X, Zhang W, Luan J, Zahr T, Qiang L. Adipokines, adiposity, and atherosclerosis. Cell Mol Life Sci 2022; 79:272. [PMID: 35503385 PMCID: PMC11073100 DOI: 10.1007/s00018-022-04286-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/11/2022] [Accepted: 04/03/2022] [Indexed: 12/12/2022]
Abstract
Characterized by a surplus of whole-body adiposity, obesity is strongly associated with the prognosis of atherosclerosis, a hallmark of coronary artery disease (CAD) and the major contributor to cardiovascular disease (CVD) mortality. Adipose tissue serves a primary role as a lipid-storage organ, secreting cytokines known as adipokines that affect whole-body metabolism, inflammation, and endocrine functions. Emerging evidence suggests that adipokines can play important roles in atherosclerosis development, progression, as well as regression. Here, we review the versatile functions of various adipokines in atherosclerosis and divide these respective functions into three major groups: protective, deteriorative, and undefined. The protective adipokines represented here are adiponectin, fibroblast growth factor 21 (FGF-21), C1q tumor necrosis factor-related protein 9 (CTRP9), and progranulin, while the deteriorative adipokines listed include leptin, chemerin, resistin, Interleukin- 6 (IL-6), and more, with additional adipokines that have unclear roles denoted as undefined adipokines. Comprehensively categorizing adipokines in the context of atherosclerosis can help elucidate the various pathways involved and potentially pave novel therapeutic approaches to treat CVDs.
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Affiliation(s)
- Longhua Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China.
| | - Zunhan Shi
- School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Xiaohui Ji
- School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Wenqian Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Jinwen Luan
- School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Tarik Zahr
- Department of Pharmacology, Columbia University, New York, NY, USA
| | - Li Qiang
- Department of Pathology and Cellular Biology and Naomi Berrie Diabetes Center, Columbia University, New York, NY, USA.
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Maggioni AP, Dondi L, Andreotti F, Ronconi G, Calabria S, Piccinni C, Pedrini A, Esposito I, Martini N. Prevalence, prescriptions, outcomes and costs of type 2 diabetes patients with or without prior coronary artery disease or stroke: a longitudinal 5-year claims-data analysis of over 7 million inhabitants. Ther Adv Chronic Dis 2021; 12:20406223211026390. [PMID: 34221306 PMCID: PMC8221674 DOI: 10.1177/20406223211026390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/01/2021] [Indexed: 01/07/2023] Open
Abstract
AIMS To analyze the prevalence, comorbidities, outcomes and costs of type 2 diabetes mellitus (T2DM) patients with and without coronary artery disease (CAD) or stroke in a population of over 7 million inhabitants. METHODS T2DM patients were identified in 2015 (accrual period) from the Ricerca e Salute (ReS) database linking administrative records to demographics. Based on 2013-2015 information, four cohorts were considered: #1 with CAD and/or stroke; #2 without CAD and/or stroke; #3 with chronic CAD but no myocardial infarction or stroke; #4 with chronic CAD undergoing percutaneous coronary interventions (PCI). Hospitalizations, drugs and other outpatient care were assessed from 2015 to 2017. RESULTS The prevalence of T2DM was 6% (441,085/7,365,954). CAD and/or stroke in the previous 3 years affected 7.5% of T2DM patients (33,153); this cohort was generally older, of male sex, with more comorbidities, prescriptions, and hospital admissions (50.5% versus 13.4% during the first follow-up year) compared to cohort #2. Yearly costs were over three-fold for cohort #1 versus #2, main drivers being hospitalizations in the former and drugs in the latter. Two-year cardiovascular events were recorded significantly more commonly in cohort #4 compared to the other cohorts. Guideline-recommended lipid-lowering therapy was <80% in all but cohort #4. CONCLUSIONS The present analysis points to three areas of potential improvement in T2DM management: (a) guideline-recommended treatment patterns of T2DM patients; (b) three-fold recurrences and costs in T2DM patients with, compared to those without, prior cardiovascular events; (c) high event rates associated with chronic CAD and PCI, warranting specific studies aimed at improved prevention.
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Affiliation(s)
- Aldo Pietro Maggioni
- Fondazione Ricerca e Salute (ReS), Rome, Italy ANMCO Research Center, Fondazione per il Tuo cuore – HCF onlus, Via La Marmora 34, Florence, 50121, Italy
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10
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Zhu YY, Yang ZY, Li P, Huang XY, Zhang XH, Ji LN, Tang JL. Comparing the incidence of major cardiovascular events and severe microvascular complications in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. World J Meta-Anal 2020; 8:400-410. [DOI: 10.13105/wjma.v8.i5.400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) causes both macrovascular and microvascular complications. However, currently, selection of glycemic measures and their thresholds to diagnose T2DM, and efficacy outcomes in evaluation of anti-diabetic drugs is predominantly informed by the relation of T2DM to microvascular complications. We can be severely mistaken on T2DM by neglecting macrovascular complications which are generally more severe, if they also occur more commonly than microvascular complications.
AIM To compare the incidence of major cardiovascular events (MACEs) and severe microvascular complications (SMICs) in T2DM patients.
METHODS MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from inception to September 2017. Cohort studies or trials of T2DM patients aged 18 years or older that reported incidence of both MACEs and SMICs were included. MACEs were defined as nonfatal myocardial infarction and stroke, and cardiovascular death, while SMICs included serious retinopathy, nephropathy and diabetic disorder. The relative risk (RR) was estimated as the incidence of MACEs divided by that of SMICs in same patients and combined with meta-analysis in a random-effect model.
RESULTS Twelve studies with a total of 16 cohorts and 387376 patients were included, and the combined RR was 2.02 (95%CI: 1.46–2.79). The higher incidence of MACEs remained in various subgroup and sensitivity analyses.
CONCLUSION Patients with T2DM are much more likely to develop MACEs than SMICs. By taking more serious consequences and relatively higher incidence into consideration, macrovascular complications deserve more emphasis in developing the diagnostic criteria of T2DM and in evaluating the efficacy of anti-diabetic drugs.
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Affiliation(s)
- Ying-Ying Zhu
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zu-Yao Yang
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ping Li
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Xin-Ying Huang
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Xue-Hong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, United States
| | - Li-Nong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Centre, Beijing 100044, China
| | - Jin-Ling Tang
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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11
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Predictors of Recurrent Ischemic Stroke in Obese Patients With Type 2 Diabetes Mellitus: A Population-based Study. J Stroke Cerebrovasc Dis 2020; 29:105173. [PMID: 32912507 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Diabetes and obesity are established risk factors for stroke. The current study aimed to assess risk factors of ischemic stroke recurrence in diabetic patients based on their body mass index (BMI). METHODS A total of 4005 diabetic patients who had a history of ischemic stroke were identified in a retrospective cross-sectional dataset from the Malaysian National Neurology Registry. Patients were classified based on BMI, and multivariable regression analysis was used to evaluate the association between risk factors and recurrent ischemic stroke. RESULTS Among obese patients, those with ischemic heart disease (aOR, 1.873; 95% CI, 1.131-3.103), received formal education (aOR, 2.236; 95% CI, 1.306-3.830), and received anti-diabetic medication (aOR, 1.788; 95% CI, 1.180-2.708) had a higher stroke recurrence risk, while receiving angiotensin receptors blockers (aOR, 0.261; 95% CI, 0.126-0.543) lowered the odds of recurrence. Overweight patients with hypertension (aOR, 1.011; 95% CI, 1.002-1.019) for over 10 years (aOR, 3.385; 95% CI, 1.088-10.532) and diabetes prior to the first stroke (aOR, 1.823; 95% CI, 1.020-3.259) as well as those received formal education (aOR, 2.403; 95% CI, 1.126-5.129) had higher odds of stroke recurrence, while receiving angiotensin-converting enzyme inhibitors (aOR, 0.244; 95% CI, 0.111-0.538) lowered the recurrence risk. Normal weight East Malaysians (aOR, 0.351; 95% CI, 0.164-0.750) receiving beta-blockers (aOR, 0.410; 95% CI, 0.174-0.966) had lower odds of stroke recurrence. CONCLUSIONS Ischemic heart disease, hypertension, receiving anti-hypertensive agents, and educational level were independent predictors of recurrent stroke in obese patients. Managing the modifiable risk factors can decrease the odds of stroke recurrence.
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12
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Liu L, Fan L, Chan M, Kraakman MJ, Yang J, Fan Y, Aaron N, Wan Q, Carrillo-Sepulveda MA, Tall AR, Tabas I, Accili D, Qiang L. PPARγ Deacetylation Confers the Antiatherogenic Effect and Improves Endothelial Function in Diabetes Treatment. Diabetes 2020; 69:1793-1803. [PMID: 32409492 PMCID: PMC7372079 DOI: 10.2337/db20-0217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in patients with diabetes, and tight glycemic control fails to reduce the risk of developing CVD. Thiazolidinediones (TZDs), a class of peroxisome proliferator-activated receptor γ (PPARγ) agonists, are potent insulin sensitizers with antiatherogenic properties, but their clinical use is limited by side effects. PPARγ deacetylation on two lysine residues (K268 and K293) induces brown remodeling of white adipose tissue and uncouples the adverse effects of TZDs from insulin sensitization. Here we show that PPARγ deacetylation confers antiatherogenic properties and retains the insulin-sensitizing effects of TZD while circumventing its detriments. We generated mice homozygous with mice with deacetylation-mimetic PPARγ mutations K268R/K293R (2KR) on an LDL-receptor knockout (Ldlr -/- ) background. 2KR:Ldlr -/- mice showed smaller atherosclerotic lesion areas than Ldlr -/- mice, particularly in aortic arches. With rosiglitazone treatment, 2KR:Ldlr -/- mice demonstrated a residual antiatherogenic response and substantial protection against bone loss and fluid retention. The antiatherosclerotic effect of 2KR was attributed to the protection of endothelium, indicated by improved endothelium-dependent vasorelaxation and repressed expression of proatherogenic factors including inducible nitric oxide synthase, interleukin-6, and NADPH oxidase 2. Therefore, manipulating PPARγ acetylation is a promising therapeutic strategy to control risk of CVD in diabetes treatment.
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Affiliation(s)
- Longhua Liu
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
- Department of Pathology and Cell Biology, Columbia University, New York, NY
| | - Lihong Fan
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
- Department of Pathology and Cell Biology, Columbia University, New York, NY
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shanxi, China
| | - Michelle Chan
- Department of Biological Sciences, Columbia University, New York, NY
| | - Michael J Kraakman
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
- Department of Medicine, Columbia University, New York, NY
| | - Jing Yang
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
- Department of Pathology and Cell Biology, Columbia University, New York, NY
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shanxi, China
| | - Yong Fan
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
- Department of Pathology and Cell Biology, Columbia University, New York, NY
| | - Nicole Aaron
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
- Department of Pharmacology, Columbia University, New York, NY
| | - Qianfen Wan
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
- Department of Pathology and Cell Biology, Columbia University, New York, NY
| | | | - Alan R Tall
- Department of Medicine, Columbia University, New York, NY
| | - Ira Tabas
- Department of Medicine, Columbia University, New York, NY
| | - Domenico Accili
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
- Department of Medicine, Columbia University, New York, NY
| | - Li Qiang
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
- Department of Pathology and Cell Biology, Columbia University, New York, NY
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Unplanned Readmission within 28 Days of Hospital Discharge in a Longitudinal Population-Based Cohort of Older Australian Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093136. [PMID: 32365917 PMCID: PMC7246843 DOI: 10.3390/ijerph17093136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 12/28/2022]
Abstract
This study aimed to estimate the incidence of 28-day unplanned readmission among older women, and associated factors. Data were used from the 1921–1926 birth cohort of the Australian Longitudinal Study on Women’s Health. Linkage of self-reported survey data with the Admitted Patient Data Collection allowed the identification of hospital admissions for each woman and the corresponding baseline characteristics. The Cox proportional-hazards model was used to identify factors associated with time to unplanned readmission, using SAS software V 9.4. (SAS Institute, Cary, NC, USA). Of 2056 women with index unplanned admission, 363 (17.5%) were readmitted within 28 days of discharge, and of these 229 (11.14%) had unplanned readmission. Among women with unplanned readmission, 24% were for the same condition as for the index hospitalisation. Cardiovascular diseases were the main diagnoses for the index admission and readmission. Unplanned readmission risk was higher if not partnered (hazard ratio (HR) = 1.43, 95% confidence interval (CI): 1.05–1.95), of non-English speaking background (HR = 1.62%, 95% CI: 1.07–2.47), more than three days length of stay on index admission (HR = 1.41%, 95% CI: 1.04–1.90) and one or two of the assessed chronic diseases (HR = 1.68, 95% CI: 1.19–2.36). At least one in ten women had unplanned readmission at some time between ages 75–95 years. Women who are not partnered, not of English-speaking background, with longer hospital stay and those with multi-morbidity, may need further efforts during their stay and on discharge to mitigate unplanned readmission.
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Bebu I, Schade D, Braffett B, Kosiborod M, Lopes-Virella M, Soliman EZ, Herman WH, Bluemke DA, Wallia A, Orchard T, Lachin JM. Risk Factors for First and Subsequent CVD Events in Type 1 Diabetes: The DCCT/EDIC Study. Diabetes Care 2020; 43:867-874. [PMID: 32001614 PMCID: PMC7085803 DOI: 10.2337/dc19-2292] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/05/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Diabetes Control and Complications Trial (DCCT) and its observational follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) demonstrated the dominant role of glycemia, second only to age, as a risk factor for a first cardiovascular event in type 1 diabetes (T1D). We now investigate the association between established risk factors and the total cardiovascular disease (CVD) burden, including subsequent (i.e., recurrent) events. RESEARCH DESIGN AND METHODS CVD events in the 1,441 DCCT/EDIC participants were analyzed separately by type (CVD death, acute myocardial infarction [MI], stroke, silent MI, angina, percutaneous transluminal coronary angioplasty/coronary artery bypass graft [PTCA/CABG], and congestive heart failure [CHF]) or as composite outcomes (CVD or major adverse cardiovascular events [MACE]). Proportional rate models and conditional models assessed associations between risk factors and CVD outcomes. RESULTS Over a median follow-up of 29 years, 239 participants had 421 CVD events, and 120 individuals had 149 MACE. Age was the strongest risk factor for acute MI, silent MI, stroke, and PTCA/CABG, while glycemia was the strongest risk factor for CVD death, CHF, and angina, second strongest for acute MI and PTCA/CABG, third strongest for stroke, and not associated with silent MI. HbA1c was the strongest modifiable risk factor for a first CVD event (CVD: HR 1.38 [95% CI 1.21, 1.56] per 1% higher HbA1c; MACE: HR 1.54 [1.30, 1.82]) and also for subsequent CVD events (CVD: incidence ratio [IR] 1.28 [95% CI 1.09, 1.51]; MACE: IR 1.89 [1.36, 2.61]). CONCLUSIONS Intensive glycemic management is recommended to lower the risk of initial CVD events in T1D. After a first event, optimal glycemic control may reduce the risk of recurrent CVD events and should be maintained.
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Affiliation(s)
- Ionut Bebu
- Biostatistics Center, The George Washington University, Rockville, MD
| | | | - Barbara Braffett
- Biostatistics Center, The George Washington University, Rockville, MD
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Lopes-Virella
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | | | - William H Herman
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Amisha Wallia
- Department of Medicine, Northwestern University, Evanston, IL
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15
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Kim SH. A Nuanced Relationship Between Prediabetes and Chronic Kidney Disease. J Clin Endocrinol Metab 2020; 105:5748205. [PMID: 32086934 DOI: 10.1210/clinem/dgaa079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Sun H Kim
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA; and Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA
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Galbete A, Cambra K, Forga L, Baquedano FJ, Aizpuru F, Lecea O, Librero J, Ibáñez B. Achievement of cardiovascular risk factor targets according to sex and previous history of cardiovascular disease in type 2 diabetes: A population-based study. J Diabetes Complications 2019; 33:107445. [PMID: 31668588 DOI: 10.1016/j.jdiacomp.2019.107445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/01/2019] [Accepted: 09/07/2019] [Indexed: 12/22/2022]
Abstract
AIMS The main objective was to assess, using real-practice primary care records, the degree of control of cardiovascular risk factor targets. Records were stratified by the presence of previous history or cardiovascular disease (CVD), and sex differences in the fulfillment profile were analyzed. METHODS This is a cross-sectional population-based study conducted in Spain. Type 2 diabetes patients over 20 years old (n = 32,638) were identified from primary care electronic health records, and the following information was extracted: glycated hemoglobin (HbA1c), systolic and diastolic blood pressure (SBP and DBP), LDL and HDL cholesterol levels, triglycerides, BMI and smoking history. RESULTS Patients with CVD had worse control of HbA1c than patients without it, (HbA1c < 7% 56.9% vs. 61.2%) but better control of BP (<130/80: 43.5% vs 38.2%) and lipids. In the group without prior CVD history, women had worse control of HbA1c, LDL, HDL, BMI and triglycerides and better control of blood pressure and smoking. These differences were maintained or accentuated in the group with previous CVD. CONCLUSIONS Women had poorer control of CV risk factors in both groups, and the sex-gap is accentuated in patients with previous CVD.
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Affiliation(s)
- Arkaitz Galbete
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Koldo Cambra
- Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
| | - Luis Forga
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
| | - Francisco Javier Baquedano
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Felipe Aizpuru
- Hospital de Txagorritxu, Servicio Vasco de Salud-Osakidetza, Vitoria Gasteiz, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Oscar Lecea
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
| | - Julián Librero
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Berta Ibáñez
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
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Ren X, Wang J, Luo S. Dynamic prediction using joint models of longitudinal and recurrent event data: A Bayesian perspective. BIOSTATISTICS & EPIDEMIOLOGY 2019; 5:250-266. [PMID: 34926969 PMCID: PMC8673593 DOI: 10.1080/24709360.2019.1693198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/30/2019] [Indexed: 06/14/2023]
Abstract
In cardiovascular disease (CVD) studies, the events of interest may be recurrent (multiple occurrences from the same individual). During the study follow-up, longitudinal measurements are often available and these measurements are highly predictive of event recurrences. It is of great clinical interest to make personalized prediction of the next occurrence of recurrent events using the available clinical information, because it enables clinicians to make more informed and personalized decisions and recommendations. To this end, we propose a joint model of longitudinal and recurrent event data. We develop a Bayesian approach for model inference and a dynamic prediction framework for predicting target subjects' future outcome trajectories and risk of next recurrent event, based on their data up to the prediction time point. To improve computation efficiency, embarrassingly parallel MCMC (EP-MCMC) method is utilized. It partitions the data into multiple subsets, runs MCMC sampler on each subset, and applies random partition trees to combine the posterior draws from all subsets. Our method development is motivated by and applied to the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), one of the largest CVD studies to compare the effectiveness of medications to treat hypertension.
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Affiliation(s)
- Xuehan Ren
- Xuehan Ren, Ph.D. Candidate, Department of Biostatistics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jue Wang
- Jue Wang, Ph.D, Genentech Inc., South San Francisco, California, USA
| | - Sheng Luo
- Corresponding author: Sheng Luo, Ph.D, Associate Professor, Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Rd, Durham, NC 27705, USA (; Phone: 919-668-8038)
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18
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Govender RD, Al-Shamsi S, Soteriades ES, Regmi D. Incidence and risk factors for recurrent cardiovascular disease in middle-eastern adults: a retrospective study. BMC Cardiovasc Disord 2019; 19:253. [PMID: 31711429 PMCID: PMC6849175 DOI: 10.1186/s12872-019-1231-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Individuals with established cardiovascular disease (CVD) and risk factors such as age, smoking, hypertension, and diabetes mellitus are at an increased risk of recurrent cardiovascular events and death. The incidence rate of recurrent CVD events varies between countries and populations. The United Arab Emirates (UAE) has one of the highest age-standardized death rates for CVD worldwide. The aim of our study was to estimate the incidence rates and determine the predictors of recurrent CVD events among UAE nationals. METHODS We investigated an outpatient-based cohort of patients with a history of CVD visiting Tawam Hospital between April 1, 2008 and December 31, 2008. They were followed-up until July 31, 2018. Univariable and multivariable Cox proportional hazards regression models were used to determine the association between major CVD risk factors and the risk of CVD recurrence. RESULTS A total of 216 patients (167 males, 49 females) with a history of CVD were included. They were followed for a median (interquartile range) of 8.1 (5.5-9.3) years, with a total of 1184 patient-years of follow-up. The overall incidence rate of recurrent CVD events was 92.1 per 1000 patient-years. The 8-year cumulative incidence was 73.7%. Age, female sex, and diabetes mellitus were significant predictors of recurrent CVD events, where females had a 1.96 times higher risk of recurrent CVD events than males. CONCLUSION Significant predictors of recurrent CVD events are older age, female sex, and diabetes mellitus. The incidence rate of recurrent CVD events was 92.1 per 1000 patient-years. Preventive measures, based on international guidelines for CVD management, may improve CVD morbidity and mortality in the UAE population.
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Affiliation(s)
- Romona D Govender
- College of Medicine and Health Sciences, Department of Family Medicine, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates.
| | - Saif Al-Shamsi
- College of Medicine and Health Sciences, Department of Internal Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Elpidoforos S Soteriades
- College of Medicine and Health Sciences, Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Dybesh Regmi
- College of Medicine and Health Sciences, Department of Family Medicine, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates
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Riesgo de mortalidad total y cardiovascular según la clasificación propuesta por las guías KDIGO en pacientes con diabetes tipo 2. Med Clin (Barc) 2019; 153:263-269. [DOI: 10.1016/j.medcli.2019.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/15/2018] [Accepted: 01/10/2019] [Indexed: 11/18/2022]
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20
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Rabizadeh S, Mansournia MA, Salehi SS, Khaloo P, Alemi H, Mirbolouk H, Blaha MJ, Esteghamati A, Nakhjavani M. Comparison of primary versus secondary prevention of cardiovascular disease in patients with type2 diabetes: Focus on achievement of ABC goals. Diabetes Metab Syndr 2019; 13:1733-1737. [PMID: 31235086 DOI: 10.1016/j.dsx.2019.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/26/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Primary and secondary prevention of cardiovascular disease is of utmost importance in the management of patients with diabetes. OBJECTIVES We studied a group of Iranian patients with type2 diabetes to provide an overview of the current status of secondary prevention of cardiovascular disease in the Middle East. METHODS This is a cross-sectional study of 2029 Patients with type2 diabetes including 323 patients with coronary artery disease (CAD) were recruited. Achievement of goals in HbA1c (A), blood pressure (B) and LDL-cholesterol(C) was assessed. RESULTS The study showed 25.3% of CAD positive patients achieved HbA1c <7% compared to 30% in CAD negative patients. The achievement of blood pressure ≤140/90 mmHg was 53.2% and 52.8% in CAD positive and CAD negative patients respectively. There was no difference in the achievement of all three ABC goals between the two groups (p = 0.733). After logistic regression analysis, history of hypertension had the highest odds ratio for CAD. CONCLUSION Although ABC control has an important impact on the prevention of cardiovascular outcomes, the ideal goal needs further efforts to be achieved.
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Affiliation(s)
- Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Salome Sadat Salehi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamid Alemi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hassan Mirbolouk
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Micheal Joseph Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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21
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Jernberg T, Lindholm D, Hasvold LP, Svennblad B, Bodegård J, Sundell Andersson K, Thuresson M, Erlinge D, Janzon M. Impact of ischaemic heart disease severity and age on risk of cardiovascular outcome in diabetes patients in Sweden: a nationwide observational study. BMJ Open 2019; 9:e027199. [PMID: 30948612 PMCID: PMC6500345 DOI: 10.1136/bmjopen-2018-027199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To compare short-term cardiovascular (CV) outcome in type 2 diabetes (T2D) patients without ischaemic heart disease (IHD), with IHD but no prior myocardial infarction (MI), and those with prior MI; and assess the impact on risk of age when initiating first-time glucose-lowering drug (GLD). DESIGN Cohort study linking morbidity, mortality and medication data from Swedish national registries. PARTICIPANTS First-time users of GLD during 2007-2016. OUTCOMES Predicted cumulative incidence for the CV outcome (MI, stroke and CV mortality) was estimated. A Cox model was developed where age at GLD start and CV risk was modelled. RESULTS 260 070 first-time GLD users were included, 221 226 (85%) had no IHD, 16 294 (6%) had stable IHD-prior MI and 22 550 (9%) had IHD+MI. T2D patients without IHD had a lower risk of CV outcome compared with the IHD populations (±prior MI), (3-year incidence 4.78% vs 5.85% and 8.04%). The difference in CV outcome was primarily driven by a relative greater MI risk among the IHD patients. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger (<60 years) patients had a relative greater risk compared with older patients. CONCLUSIONS T2D patients without IHD had a lower risk of the CV outcome compared with the T2D populations with IHD, primarily driven by a greater risk of MI. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger patients had a relative greater risk compared with older patients. Our findings suggest that intense risk prevention should be the key strategy in the management of T2D patients, especially for younger patients.
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Affiliation(s)
- Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Daniel Lindholm
- UCR-Uppsala Clinical Research center, Uppsala Clinical Research center, Uppsala, Sweden
| | | | - Bodil Svennblad
- UCR-Uppsala Clinical Research center, Uppsala Clinical Research center, Uppsala, Sweden
| | | | | | | | | | - Magnus Janzon
- Cardiology, Linkopings Universitet, Linkoping, Sweden
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22
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Fitchett D, Inzucchi SE, Cannon CP, McGuire DK, Scirica BM, Johansen OE, Sambevski S, Kaspers S, Pfarr E, George JT, Zinman B. Empagliflozin Reduced Mortality and Hospitalization for Heart Failure Across the Spectrum of Cardiovascular Risk in the EMPA-REG OUTCOME Trial. Circulation 2019; 139:1384-1395. [PMID: 30586757 PMCID: PMC6416009 DOI: 10.1161/circulationaha.118.037778] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/30/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the EMPA-REG OUTCOME trial (BI 10773 [Empagliflozin] Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) in patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease, in comparison with placebo, empagliflozin reduced the risks of 3-point major adverse cardiovascular events (3-point MACE), cardiovascular and all-cause death, and hospitalization for heart failure. We investigated whether these effects varied across the spectrum of baseline cardiovascular risk. METHODS Cardiovascular death, all-cause mortality, 3-point MACE, and hospitalization for heart failure in the pooled empagliflozin and placebo groups were analyzed in subgroups by prior myocardial infarction and stroke at baseline, and by estimated baseline cardiovascular risk based on the 10-point TIMI (Thrombolysis In Myocardial Infarction) Risk Score for Secondary Prevention. RESULTS Of 7020 patients who received the study drug, 65% had a prior myocardial infarction or stroke, and 12%, 40%, 30%, and 18% were at low, intermediate, high, and highest estimated cardiovascular risk according to TIMI Risk Score for Secondary Prevention (≤2, 3, 4, and ≥5 points, respectively). In the placebo group, 3-point MACE occurred during the trial in 7.3%, 9.4%, 12.6%, and 20.6% of patients at low, intermediate, high, and highest estimated baseline risk, respectively. Relative reductions in risk of cardiovascular death, all-cause mortality, 3-point MACE and hospitalization for heart failure with empagliflozin versus placebo were consistent in patients with and without prior myocardial infarction and/or stroke and across subgroups by TIMI Risk Score for Secondary Prevention at baseline ( P>0.05 for randomized group-by-subgroup interactions). CONCLUSIONS Despite all patients having atherosclerotic cardiovascular disease, patients in EMPA-REG OUTCOME demonstrated a broad risk spectrum for cardiovascular events. Reductions in key cardiovascular outcomes and mortality with empagliflozin versus placebo were consistent across the range of cardiovascular risk. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01131676.
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Affiliation(s)
- David Fitchett
- St Michael's Hospital, Division of Cardiology, University of Toronto, Canada (D.F.)
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT (S.E.I.)
| | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA (C.P.C., B.M.S.)
| | - Darren K McGuire
- University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Benjamin M Scirica
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA (C.P.C., B.M.S.)
| | | | - Steven Sambevski
- Boehringer Ingelheim International GmbH, Ingelheim, Germany (S.S., S.K., E.P., J.T.G.)
| | - Stefan Kaspers
- Boehringer Ingelheim International GmbH, Ingelheim, Germany (S.S., S.K., E.P., J.T.G.)
| | - Egon Pfarr
- Boehringer Ingelheim International GmbH, Ingelheim, Germany (S.S., S.K., E.P., J.T.G.)
| | - Jyothis T George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany (S.S., S.K., E.P., J.T.G.)
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Canada (B.Z.)
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23
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Cavender MA, White WB, Liu Y, Massaro JM, Bergenstal RM, Mehta CR, Zannad F, Heller S, Cushman WC, Cannon CP. Total cardiovascular events analysis of the EXAMINE trial in patients with type 2 diabetes and recent acute coronary syndrome. Clin Cardiol 2018; 41:1022-1027. [PMID: 29652078 DOI: 10.1002/clc.22960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 01/19/2023] Open
Abstract
Alogliptin, a dipeptidyl peptidase-4 inhibitor, is approved for the treatment of patients with type 2 diabetes (T2DM). EXAMINE was a randomized controlled clinical trial designed to demonstrate the cardiovascular (CV) safety of alogliptin. In the trial, 5380 patients with established T2DM who had a recent acute coronary syndrome event (between 15 and 90 days) were randomized to treatment with either alogliptin or placebo. To better understand and describe the CV safety of alogliptin, we analyzed data from the EXAMINE trial to determine whether treatment with alogliptin affected recurrent and total CV events. Poisson regression analysis compared the total number of occurrences of CV death, MI, stroke, unstable angina, and coronary revascularization between all patients randomized to alogliptin vs placebo groups. Patients with recurrent CV events were older and more likely to have renal disease and history of heart failure. There were 1100 first CV events and an additional 666 recurrent events over a median of 18 months of follow-up. There were no significant differences with regard to total number of events in patients treated with alogliptin (n = 873) or placebo (n = 893; P = 0.52). Furthermore, there were no differences in the types of events seen in patients treated with alogliptin or placebo. Alogliptin did not increase the risk of either first or recurrent CV events when compared with placebo in patients with T2DM and recent acute coronary syndrome. These data support the CV safety of alogliptin in patients who are at increased risk of future CV events.
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Affiliation(s)
- Matthew A Cavender
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Yuyin Liu
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Joseph M Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | | | - Cyrus R Mehta
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Faiez Zannad
- Department of Medicine, INSERM 1143, Université de Lorraine, Nancy, France
| | - Simon Heller
- Department of Medicine, University of Sheffield and Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - William C Cushman
- Department of Medicine, Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee
| | - Christopher P Cannon
- Baim Institute for Clinical Research, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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24
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Extraction of unadjusted estimates of prognostic association for meta-analysis: simulation methods as good alternatives to trend and direct method estimation. J Clin Epidemiol 2018; 99:153-163. [DOI: 10.1016/j.jclinepi.2017.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 12/04/2017] [Accepted: 12/20/2017] [Indexed: 11/24/2022]
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25
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Chaddha A, Smith MA, Palta M, Johnson HM. Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: A multidisciplinary group practice observational study. J Clin Hypertens (Greenwich) 2018; 20:891-901. [PMID: 29683249 DOI: 10.1111/jch.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/06/2018] [Accepted: 03/11/2018] [Indexed: 11/27/2022]
Abstract
Patients with diabetes mellitus and cardiovascular disease have a high risk of mortality and/or recurrent cardiovascular events. Hypertension control is critical for secondary prevention of cardiovascular events. The objective was to determine rates and predictors of achieving hypertension control among Medicare patients with diabetes and uncontrolled hypertension after hospital discharge for an initial cardiac event. A retrospective analysis of linked electronic health record and Medicare data was performed. The primary outcome was hypertension control within 1 year after hospital discharge for an initial cardiac event. Cox proportional hazard models assessed sociodemographics, medications, utilization, and comorbidities as predictors of control. Medicare patients with diabetes were more likely to achieve hypertension control when prescribed beta-blockers at discharge or with a history of more specialty visits. Adults ≥ 80 were more likely to achieve control with diuretics. These findings demonstrate the importance of implementing guideline-directed multidisciplinary care in this complex and high-risk population.
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Affiliation(s)
- Ashish Chaddha
- Division of Cardiology, Department of Medicine, William Beaumont Hospital, Royal Oak, MI, USA
| | - Maureen A Smith
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Heather M Johnson
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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26
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Lin FJ, Tseng WK, Yin WH, Yeh HI, Chen JW, Wu CC. Residual Risk Factors to Predict Major Adverse Cardiovascular Events in Atherosclerotic Cardiovascular Disease Patients with and without Diabetes Mellitus. Sci Rep 2017; 7:9179. [PMID: 28835613 PMCID: PMC5569020 DOI: 10.1038/s41598-017-08741-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/18/2017] [Indexed: 12/19/2022] Open
Abstract
A prospective observational study was conducted to investigate the residual risk factors to predict recurrence of major adverse cardiovascular events (MACE) in atherosclerotic cardiovascular disease (ASCVD) patients with a high prevalence under lipid-lowering therapy, particularly in the subpopulations of diabetic and nondiabetic individuals. A total of 5,483 adults (with a mean age of 66.4 and 73.3% male) with established coronary heart disease, cerebrovascular disease, or peripheral artery disease were identified from the T-SPARCLE multi-center registry. Of them, 38.6% had diabetes. The residual risk factors for MACE are divergent in these atherosclerotic patients with and without diabetes. In diabetic subpopulation, the risk of MACE was significantly increased with heart failure (HF), chronic kidney disease (CKD) stage 4-5 (vs. stage 1-2), without beta blocker use, and higher non-HDL-C, after controlling for covariates including statin use and the intensity of therapy. Increased LDL-C and TG levels were also associated with increased risk, but to a much less extent. Among nondiabetic individuals, HF, CKD stage 4-5, and history of myocardial infarction were the significant independent predictors of MACE. It is suggested that ASCVD patients with concomitant diabetes need stricter control of lipid, particularly non-HDL-C levels, to reduce cardiovascular risk when on statin therapy.
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Affiliation(s)
- Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Kung Tseng
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan.,Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
| | - Jaw-Wen Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Chau-Chung Wu
- Department of Internal Medicine (Cardiology Section), National Taiwan University Hospital, Taipei, Taiwan. .,Graduate Institute of Medical Education & Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan.
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27
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Engelen SE, van der Graaf Y, Stam-Slob MC, Grobbee DE, Cramer MJ, Kappelle LJ, de Borst GJ, Visseren FLJ, Westerink J. Incidence of cardiovascular events and vascular interventions in patients with type 2 diabetes. Int J Cardiol 2017; 248:301-307. [PMID: 28802735 DOI: 10.1016/j.ijcard.2017.07.081] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/02/2017] [Accepted: 07/13/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Diabetes mellitus is associated with an increased risk for cardiovascular morbidity and mortality. The vascular burden in terms of incidence of cardiovascular events (CVE) and vascular interventions is however poorly quantified. In this study we evaluated the incidence rates of CVE and vascular interventions in patients with type 2 diabetes (T2DM) with and without cardiovascular disease (CVD) in comparison to patients without type 2 diabetes. RESEARCH DESIGN AND METHODS In a cohort of 9.808 high-risk patients with and without cardiovascular disease and type 2 diabetes originated from the ongoing, single-center prospective SMART (Second Manifestations of ARTerial disease) cohort, the number and incidence rates of CVE and interventions were calculated. The incidence rates were adjusted for confounders using Poisson regression models. CVE were defined as vascular death, stroke and myocardial infarction (MI). Interventions were defined as percutaneous coronary intervention, coronary artery bypass grafting, percutaneous transluminal angioplasty or stenting of the peripheral arteries and amputation. RESULTS Patients with T2DM and CVD had a 4-fold higher incidence rate of CVE and a 8-fold higher incidence rate of vascular interventions compared to high-risk patients without T2DM and CVD after adjusting for confounders. The incidence rate for the composite of non-fatal MI, non-fatal stroke and vascular death was 5.8 per 1000person-years in patients without T2DM or CVD at baseline, 15.2 per 1000person-years in patients with T2DM but without CVD at baseline, 26.0 per 1000person-years in patients without T2DM but with CVD and 40.7 per 1000person-years in patients with both T2DM and CVD at baseline. A similar increasing incidence rate was seen for all vascular interventions from patients without T2DM or CVD to patients with both T2DM and CVD. CONCLUSIONS Patients with type 2 diabetes or CVD are subject to an increased incidence of cardiovascular events and interventions compared to high-risk patients without type 2 diabetes or vascular disease. Patients with type 2 diabetes and CVD have the highest incidence of new cardiovascular diseases and vascular interventions when compared to patients without type 2 diabetes and CVD. These results underline the need for optimal risk factor treatment as well as the need for new prevention and treatment strategies in this very high risk population.
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Affiliation(s)
- Suzanne E Engelen
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Manon C Stam-Slob
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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28
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Taravatmanesh S, Khalili D, Khodakarim S, Asgari S, Hadaegh F, Azizi F, Sabour S. Determining the Factors Associated with Cardiovascular Disease Recurrence: Tehran Lipid and Glucose Study. J Tehran Heart Cent 2017; 12:107-113. [PMID: 29062377 PMCID: PMC5643867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Several studies have emphasized the importance of cardiovascular disease (CVD) prevention. However, there is a dearth of data on the prevention of cardiovascular disease recurrence. The present study was the 1st in Iran to evaluate factors associated with CVD recurrence. Methods: This prospective cohort study was conducted on 483 subjects (> 30 years old) with a history of CVD who participated in the Tehran Lipid and Glucose Study and were followed up for 12 years (1999-2012). The relationships between the most important established risk factors for CVD and CVD recurrence were evaluated. Results: Totally, 258 (53.4%) men and 225(46.5%) women at a mean age of 59.2 ± 10.7 years were recruited in the study. Our results showed that over the 12-year follow-up, the incidence of a recurrent event (per 100 person-years) was 48.5. Further, after controlling the possible confounding factors, the following variables had a significant relationship with CVD recurrence: age (HR = 1.02; p value = 0. 001), male sex (HR = 1.4; p value = 0.012), smoking (HR = 1.7; p value = 0.004), and increased fasting blood sugar (HR = 2.1; p value = 0.001). Conclusion: We found that the established variables in the development of CVD (i.e., age, sex, and smoking) played an important role in the risk of CVD recurrence.
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Affiliation(s)
- Samira Taravatmanesh
- Department of Epidemiology, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Soheila Khodakarim
- Department of Epidemiology, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidon Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Siamak Sabour
- Safety Promotions and Injuries Prevention Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Author: Siamak Sabour, Associate Professor of Clinical Epidemiology, Safety Promotions and Injuries Prevention Research Centre, Department of Clinical Epidemiology, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 198353-5511. Tel: +98 21 22432041. Fax: +98 21 22432040. E-mail: .
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29
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Mansournia MA, Holakouie-Naieni K, Fahimfar N, Almasi-Hashiani A, Cheraghi Z, Ayubi E, Hadaegh F, Eskandari F, Azizi F, Khalili D. Risk of Coronary Heart Events Based on Rose Angina Questionnaire and ECG Besides Diabetes and Other Metabolic Risk Factors: Results of a 10-Year Follow-up in Tehran Lipid and Glucose Study. Int J Endocrinol Metab 2017; 15:e42713. [PMID: 28848610 PMCID: PMC5556326 DOI: 10.5812/ijem.42713] [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: 10/01/2016] [Revised: 02/27/2017] [Accepted: 04/09/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND High-risk individuals for CHD could be diagnosed by some non-invasive and low-priced techniques such as Minnesota ECG coding and rose angina questionnaire (RQ). OBJECTIVES The present study aimed at determining the risk of incident CHD according to ECG and RQ besides diabetes and other metabolic risk factors in our population. METHODS Participants comprised of 5431 individuals aged ≥ 30 years within the framework of Tehran lipid and glucose study. Based on their status on history of CHD, ECG, and RQ at baseline, all participants were classified to 5 following groups: (1) History-Rose-ECG- (the reference group); (2) History-Rose+ECG-; (3) History-Rose-ECG+; (4) History-Rose+ECG+; and (5) History+. We used Cox regression model to find the role of ECG and RQ on CHD, independent of other risk factors. RESULTS Overall, 562 CHD events were detected during the median of 10.3 years follow-up. CHD incidence rates were 55.9 and 9.09 cases per 1000 person-year for participants with and without history of CHD, respectively. Hazard ratios (HRs) (95% CIs) were 4.11 (3.27 - 5.11) for History + and 2.18 (1.63 - 2.90), 1.92 (1.47 - 2.51), and 2.48 (1.46 - 4.20) for History-Rose+ECG-, History-Rose-ECG+, and History-Rose+ECG+, respectively. RQ and ECG had the same HRs as high as those for hypertension and hypercholesterolemia; however, diabetes showed statistically and clinically more effects on CVD than RQ and ECG. CONCLUSIONS RQ in general and, ECG especially in asymptomatic patients, were good predictors for CHD events in both Iranian males and females; however, their predictive powers were lower than that of diabetes.
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Affiliation(s)
- Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Cheraghi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Erfan Ayubi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Eskandari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Davood Khalili, Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2122432500, Fax: +98-2122416264, E-mail:
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30
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Li W, Li M, Gao C, Wang X, Qi D, Liu J, Jin Q. Impact of type 2 diabetes mellitus on recurrent myocardial infarction in China. Diab Vasc Dis Res 2016; 13:395-404. [PMID: 27390227 DOI: 10.1177/1479164116653606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
To evaluate the influence of type 2 diabetes mellitus on the long-term outcomes of Chinese patients with previous myocardial infarction, we studied 864 patients with previous myocardial infarction, including 251 with type 2 diabetes mellitus and 613 without type 2 diabetes mellitus, over a median follow-up time of 2.9 years. The type 2 diabetes mellitus patients were subdivided into 95 insulin-treated diabetes mellitus and 156 non-insulin-treated diabetes mellitus subjects. The crude incidences (per 1000 patient-years) in the type 2 diabetes mellitus subjects versus the non-type 2 diabetes mellitus subjects were 43.7 versus 25.1 for recurrent myocardial infarction, 68.7 versus 28.3 for all-cause death and 99.8 versus 49.9 for the composite end point (i.e. recurrent myocardial infarction or all-cause death). Cox regression analysis showed that the adjusted hazard ratios for recurrent myocardial infarction, all-cause death and their combination were 1.67 (95% confidence interval: 1.06-2.74), 1.90 (1.25-2.90) and 1.72 (1.23-2.40), respectively. Significant associations were also observed between insulin treatment and all-cause death. Our findings suggested that type 2 diabetes mellitus is an independent risk factor for recurrent myocardial infarction, all-cause death and the composite end point among previous myocardial infarction patients.
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Affiliation(s)
- Wentao Li
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Muwei Li
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xianpei Wang
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Datun Qi
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jun Liu
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Qiangsong Jin
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Cha SA, Yun JS, Lim TS, Min K, Song KH, Yoo KD, Park YM, Ahn YB, Ko SH. Diabetic Cardiovascular Autonomic Neuropathy Predicts Recurrent Cardiovascular Diseases in Patients with Type 2 Diabetes. PLoS One 2016; 11:e0164807. [PMID: 27741306 PMCID: PMC5065186 DOI: 10.1371/journal.pone.0164807] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/30/2016] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular autonomic neuropathy (CAN) is a risk factor for cardiovascular disease (CVD) and mortality in patients with type 2 diabetes. This study evaluated the relationship between CAN and recurrent CVD in type 2 diabetes. A total of 206 patients with type 2 diabetes who had a history of CVD within 3 years of enrollment were consecutively recruited from January 2001 to December 2009 and followed-up until December 2015. Cardiovascular autonomic function tests were performed using the following heart rate variability parameters: expiration-to-inspiration ratio, response to Valsalva maneuver and standing. We estimated the recurrence of CVD events during the follow-up period. A total of 159 (77.2%) of the 206 patients enrolled completed the follow up, and 78 (49.1%) patients had recurrent episodes of CVD, with an incidence rate of 75.6 per 1,000 patient-years. The mean age and diabetes duration were 62.5 ± 8.7 and 9.2 ± 6.9 years, respectively. Patients who developed recurrent CVD also exhibited hypertension (P = 0.004), diabetic nephropathy (P = 0.012), higher mean systolic blood pressure (P = 0.006), urinary albumin excretion (P = 0.015), and mean triglyceride level (P = 0.035) than did patients without recurrent CVD. Multivariable Cox hazard regression analysis revealed that definite CAN was significantly associated with an increased risk of recurrent CVD (hazard ratio [HR] 3.03; 95% confidence interval [CI] 1.39−6.60; P = 0.005). Definite CAN was an independent predictor for recurrent CVD in patients with type 2 diabetes who had a known prior CVD event.
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Affiliation(s)
- Seon-Ah Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Seok Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoungil Min
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Moon Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States of America
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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Lee EY, Yang HK, Lee J, Kang B, Yang Y, Lee SH, Ko SH, Ahn YB, Cha BY, Yoon KH, Cho JH. Triglyceride glucose index, a marker of insulin resistance, is associated with coronary artery stenosis in asymptomatic subjects with type 2 diabetes. Lipids Health Dis 2016; 15:155. [PMID: 27633375 PMCID: PMC5024477 DOI: 10.1186/s12944-016-0324-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/02/2016] [Indexed: 12/21/2022] Open
Abstract
Background Insulin resistance is one of the most important contributing factors to cardiovascular disease. This study aimed to investigate the association between coronary artery stenosis (CAS) and triglyceride glucose index (TyG index), a simple insulin resistance marker, in asymptomatic subjects with type 2 diabetes. Methods We recruited asymptomatic adults with type 2 diabetes but without previous history of coronary heart disease (n = 888). Significant CAS was defined as maximum intraluminal stenosis ≥70 % by coronary CT angiography. TyG index was calculated as log [fasting triglycerides (mg/dl) x fasting glucose (mg/dl)/2]. Results Mean age was 63.8 ± 9.5 and 58.9 % of the subjects were men. We analyzed the participants according to the tertile of TyG index. The TyG index was correlated with HOMA-IR (r = 0.397, P < 0.001), and subjects with higher tertile of TyG index were younger but showed worse clinical and metabolic parameters. The prevalence of CAS was higher in subjects with higher tertile of TyG compared with those with lower tertile of TyG (14 % vs. 7.8 %, P = 0.022). On multiple regression analysis, the highest tertile of TyG index was an independent risk factor for CAS after adjustment for other confounders (odds ratio, 3.19 [95 % CI, 1.371–7.424]). Subgroup analysis showed that TyG index showed more significant association with CAS in patients with risk factors such as old age, longer duration of diabetes, poor glycemic control, no statin use, and male gender. Conclusion Higher TyG index is associated with increased risk of CAS in asymptomatic subjects with type 2 diabetes, particularly when they have risk factors for cardiovascular disease. Trial registration This study was retrospectively registered in ClinicalTrials. gov with the registration number of NCT02070926 in Feb 23, 2014.
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Affiliation(s)
- Eun Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hae Kyung Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Joonyub Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Borami Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yeoree Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong Yun Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.,Institute of Catholic Ubiquitous Health Care, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. .,Institute of Catholic Ubiquitous Health Care, The Catholic University of Korea, Seoul, Korea.
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McEwan P, Bennett H, Fellows J, Priaulx J, Bergenheim K. The Health Economic Value of Changes in Glycaemic Control, Weight and Rates of Hypoglycaemia in Type 1 Diabetes Mellitus. PLoS One 2016; 11:e0162441. [PMID: 27632534 PMCID: PMC5025276 DOI: 10.1371/journal.pone.0162441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/23/2016] [Indexed: 11/18/2022] Open
Abstract
AIMS Therapy-related consequences of treatment for type 1 diabetes mellitus (T1DM), such as weight gain and hypoglycaemia, act as a barrier to attaining optimal glycaemic control, indirectly influencing the incidence of vascular complications and associated morbidity and mortality. This study quantifies the individual and combined contribution of changes in hypoglycaemia frequency, weight and HbA1c to predicted quality-adjusted life-years (QALYs) within a T1DM population. MATERIALS AND METHODS We describe the Cardiff Type 1 Diabetes (CT1DM) Model, originally informed by the Diabetes Control and Complications Trial (DCCT) and updated with the Epidemiology of Diabetes Interventions and Complications (EDIC) study and Swedish National Diabetes Registry for microvascular and cardiovascular complications respectively. We report model validation results and the QALY impact of HbA1c, weight and hypoglycaemia changes. RESULTS Validation results demonstrated coefficients of determination for clinical endpoints of R2 = 0.863 (internal R2 = 0.999; external R2 = 0.823), costs R2 = 0.980 and QALYs R2 = 0.951. Achieving and maintaining a 1% HbA1c reduction was estimated to provide 0.61 additional discounted QALYs. Weight changes of ±1kg, ±2kg or ±3kg led to discounted QALY changes of ±0.03, ±0.07 and ±0.10 respectively, while modifying hypoglycaemia frequency by -10%, -20% or -30% resulted in changes of -0.05, -0.11 and -0.17. The differences in discounted costs, life-years and QALYs associated with HbA1c 6% versus 10% were -£19,037, 2.49 and 2.35 respectively. CONCLUSIONS Using a model updated with contemporary epidemiological data, this study presents an outcome-focused perspective to assessing the health economic consequences of differing levels of glycaemic control in T1DM with and without weight and hypoglycaemia effects.
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Affiliation(s)
- Phil McEwan
- Health Economics and Outcomes Research Ltd., Mulberry Drive, Cardiff, United Kingdom
| | - Hayley Bennett
- Health Economics and Outcomes Research Ltd., Mulberry Drive, Cardiff, United Kingdom
| | - Jonathan Fellows
- Health Economics and Outcomes Research Ltd., Mulberry Drive, Cardiff, United Kingdom
| | - Jennifer Priaulx
- Global Health Economics and Outcomes Research, AstraZeneca, London, United Kingdom
| | - Klas Bergenheim
- Global Health Economics and Outcomes Research, AstraZeneca, Molndal, Sweden
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Perera R, McFadden E, McLellan J, Lung T, Clarke P, Pérez T, Fanshawe T, Dalton A, Farmer A, Glasziou P, Takahashi O, Stevens J, Irwig L, Hirst J, Stevens S, Leslie A, Ohde S, Deshpande G, Urayama K, Shine B, Stevens R. Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling. Health Technol Assess 2016; 19:1-401, vii-viii. [PMID: 26680162 DOI: 10.3310/hta191000] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Various lipid measurements in monitoring/screening programmes can be used, alone or in cardiovascular risk scores, to guide treatment for prevention of cardiovascular disease (CVD). Because some changes in lipids are due to variability rather than true change, the value of lipid-monitoring strategies needs evaluation. OBJECTIVE To determine clinical value and cost-effectiveness of different monitoring intervals and different lipid measures for primary and secondary prevention of CVD. DATA SOURCES We searched databases and clinical trials registers from 2007 (including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Clinical Trials Register, the Current Controlled Trials register, and the Cumulative Index to Nursing and Allied Health Literature) to update and extend previous systematic reviews. Patient-level data from the Clinical Practice Research Datalink and St Luke's Hospital, Japan, were used in statistical modelling. Utilities and health-care costs were drawn from the literature. METHODS In two meta-analyses, we used prospective studies to examine associations of lipids with CVD and mortality, and randomised controlled trials to estimate lipid-lowering effects of atorvastatin doses. Patient-level data were used to estimate progression and variability of lipid measurements over time, and hence to model lipid-monitoring strategies. Results are expressed as rates of true-/false-positive and true-/false-negative tests for high lipid or high CVD risk. We estimated incremental costs per quality-adjusted life-year. RESULTS A total of 115 publications reported strength of association between different lipid measures and CVD events in 138 data sets. The summary adjusted hazard ratio per standard deviation of total cholesterol (TC) to high-density lipoprotein (HDL) cholesterol ratio was 1.25 (95% confidence interval 1.15 to 1.35) for CVD in a primary prevention population but heterogeneity was high (I(2) = 98%); similar results were observed for non-HDL cholesterol, apolipoprotein B and other ratio measures. Associations were smaller for other single lipid measures. Across 10 trials, low-dose atorvastatin (10 and 20 mg) effects ranged from a TC reduction of 0.92 mmol/l to 2.07 mmol/l, and low-density lipoprotein reduction of between 0.88 mmol/l and 1.86 mmol/l. Effects of 40 mg and 80 mg were reported by one trial each. For primary prevention, over a 3-year period, we estimate annual monitoring would unnecessarily treat 9 per 1000 more men (28 vs. 19 per 1000) and 5 per 1000 more women (17 vs. 12 per 1000) than monitoring every 3 years. However, annual monitoring would also undertreat 9 per 1000 fewer men (7 vs. 16 per 1000) and 4 per 1000 fewer women (7 vs. 11 per 1000) than monitoring at 3-year intervals. For secondary prevention, over a 3-year period, annual monitoring would increase unnecessary treatment changes by 66 per 1000 men and 31 per 1000 women, and decrease undertreatment by 29 per 1000 men and 28 per 1000 men, compared with monitoring every 3 years. In cost-effectiveness, strategies with increased screening/monitoring dominate. Exploratory analyses found that any unknown harms of statins would need utility decrements as large as 0.08 (men) to 0.11 (women) per statin user to reverse this finding in primary prevention. LIMITATION Heterogeneity in meta-analyses. CONCLUSIONS While acknowledging known and potential unknown harms of statins, we find that more frequent monitoring strategies are cost-effective compared with others. Regular lipid monitoring in those with and without CVD is likely to be beneficial to patients and to the health service. Future research should include trials of the benefits and harms of atorvastatin 40 and 80 mg, large-scale surveillance of statin safety, and investigation of the effect of monitoring on medication adherence. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003727. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rafael Perera
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emily McFadden
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie McLellan
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tom Lung
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Philip Clarke
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Teresa Pérez
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas Fanshawe
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Dalton
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Farmer
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Osamu Takahashi
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | | | - Les Irwig
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Jennifer Hirst
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Stevens
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Asuka Leslie
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Sachiko Ohde
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Gautam Deshpande
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Kevin Urayama
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Brian Shine
- Oxford University Hospitals Trust, Oxford, UK
| | - Richard Stevens
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Bliden KP, Patrick J, Pennell AT, Tantry US, Gurbel PA. Drug delivery and therapeutic impact of extended-release acetylsalicylic acid. Future Cardiol 2015; 12:45-58. [PMID: 26356085 DOI: 10.2217/fca.15.60] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Current treatment guidelines recommend once-daily, low-dose acetylsalicylic acid (ASA; aspirin) for secondary prevention of cardiovascular events. However, the anti-thrombotic benefits of traditional ASA formulations may not extend over a 24-h period, especially in patients at high risk for a recurrent cardiovascular event. A next-generation, extended-release ASA formulation (ER-ASA) has been developed to provide 24-h anti-thrombotic coverage with once-daily dosing. The pharmacokinetics of ER-ASA indicates slower absorption and prolonged ASA release versus immediate-release ASA, with a favorable safety profile. ER-ASA minimizes systemic ASA absorption and provides sustained antiplatelet effects over a 24-h period.
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Affiliation(s)
- Kevin P Bliden
- Sinai Center for Thrombosis Research, Baltimore, MD, USA
| | - Jeff Patrick
- New Haven Pharmaceuticals, Inc., North Haven, CT, USA
| | | | - Udaya S Tantry
- Sinai Center for Thrombosis Research, Baltimore, MD, USA
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research, Baltimore, MD, USA
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Whole-Body MR Imaging Including Angiography: Predicting Recurrent Events in Diabetics. Eur Radiol 2015; 26:1420-30. [DOI: 10.1007/s00330-015-3936-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/02/2015] [Accepted: 07/20/2015] [Indexed: 01/15/2023]
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Gimeno-Orna JA, Blasco-Lamarca Y, Campos-Gutierrez B, Molinero-Herguedas E, Lou-Arnal LM, García-García B. Risk of mortality associated to chronic kidney disease in patients with type 2 diabetes mellitus: a 13-year follow-up. Nefrologia 2015; 35:487-92. [PMID: 26306974 DOI: 10.1016/j.nefro.2015.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/17/2015] [Accepted: 05/11/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Our aim was to assess the usefulness of glomerular filtration rate (GFR) and urinary albumin excretion (UAE) to predict the risk of mortality in patients with type 2 diabetes mellitus. MATERIAL AND METHODS This is a prospective cohort study in patients with type 2 diabetes mellitus. Clinical end-point was mortality rate. GFR was measured in ml/min/1.73 m2 and stratified in 3 categories (≥60; 45-59; <45); UAE was measured in mg/24hours and was also stratified in 3 categories (<30; 30-300; >300). Mortality rates were reported per 1000 patient-years. Cox regression models were used to predict mortality risk associated with combined GFR and UAE. The predictive power was estimated with C-Harrell statistic. RESULTS A total of 453 patients (39.3% males), aged 64.9 (SD 9.3) years were included; mean diabetes duration was 10.4 (SD 7.5) years. Median follow-up was 13 years. Total mortality rate was 39.5/1000. The progressive increase in mortality in the successive categories of GFR and UAE was statistically significant (P<.001). In a multivariable analysis, UAE (HR30-300=1.02 and HR>300=2.83; X2=11.6; P =.003) and GFR (HR45-59=1.34 and HR<45=1.84; X2=6.4; P =.041) were independent predictors for mortality, with no significant interaction. Simultaneous inclusion of GFR and UAE improved the predictive power of models (C-Harrell 0.741 vs. 0.726; P =.045). CONCLUSIONS GFR and UAE are independent predictors for mortality in type 2 diabetic patients and do not show a statistically significant interaction.
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Affiliation(s)
| | - Yolanda Blasco-Lamarca
- Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Ferrannini E, DeFronzo RA. Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes. Eur Heart J 2015; 36:2288-96. [PMID: 26063450 DOI: 10.1093/eurheartj/ehv239] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/16/2015] [Indexed: 12/11/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is characterized by multiple pathophysiologic abnormalities. With time, multiple glucose-lowering medications are commonly required to reduce and maintain plasma glucose concentrations within the normal range. Type 2 diabetes mellitus individuals also are at a very high risk for microvascular complications and the incidence of heart attack and stroke is increased two- to three-fold compared with non-diabetic individuals. Therefore, when selecting medications to normalize glucose levels in T2DM patients, it is important that the agent not aggravate, and ideally even improve, cardiovascular risk factors (CVRFs) and reduce cardiovascular morbidity and mortality. In this review, we examine the effect of oral (metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP4 inhibitors, SGLT2 inhibitors, and α-glucosidase inhibitors) and injectable (glucagon-like peptide-1 receptor agonists and insulin) glucose-lowering drugs on established CVRFs and long-term studies of cardiovascular outcomes. Firm evidence that in T2DM cardiovascular disease can be reversed or prevented by improving glycaemic control is still incomplete and must await large, long-term clinical trials in patients at low risk using modern treatment strategies, i.e., drug combinations designed to maximize HbA1c reduction while minimizing hypoglycaemia and excessive weight gain.
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Affiliation(s)
- Ele Ferrannini
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Ralph A DeFronzo
- Diabetes Division, University of Texas Health Science Center, San Antonio, TX, USA
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Modesti A, Bartaloni R, Bellagamba F, Caglieri R, Cenori K, Ciampalini G, Costagli A, Galloni V, Del Papa C, Modesti L, Dell'Omo G, Pedrinelli R. Health care delivery in type 2 diabetes. A survey in an Italian primary care practice. Prim Care Diabetes 2015; 9:9-14. [PMID: 24908631 DOI: 10.1016/j.pcd.2014.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
AIMS Evidence-based guidelines provide targets and performance measures for the treatment of type 2 diabetic patients but a wide gap separates guidelines-driven recommendations from their clinical application, a phenomenon hindering the transfer of proven benefits to affected populations. METHODS We analyzed the quality of diabetic care delivered by 8 general practitioners joint in a group practice attending 571 diabetic patients (5.6% of the total enlisted subjects) by assessing process (% of HbA1c, SBP and LDL-C determinations) and intermediate outcome (% of patients with HbA1c <7% vs >8%, systolic BP <130 mmHg vs >140 mmHg, LDL-cholesterol <100 mg/dL vs >130 mg/dL) indicators. RESULTS HbA1c was at target in 49% of patients and >8% in 22%; SBP and LDL-C determination was available in about two-thirds of patients, only a minority at target for SBP and LDL-C. Antihyperglycemic and antihypertensive treatment was prescribed in most patients but only a third was on statins. During the post-evaluation phase, percentages of patients with HbA1c >8%, SBP < 130 mmHg and LDL-C < 100 mg/dL and the drug prescription pattern did not change. CONCLUSIONS Several weaknesses affect primary care delivery to type 2 diabetic patients and efforts are needed to improve the management of this high-risk group.
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Affiliation(s)
- Andrea Modesti
- "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy
| | - Roberto Bartaloni
- "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy
| | - Franca Bellagamba
- "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy
| | - Rossano Caglieri
- "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy
| | - Katia Cenori
- "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy
| | - Giorgio Ciampalini
- "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy
| | - Attilio Costagli
- "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy
| | - Vanni Galloni
- "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy
| | - Cecilia Del Papa
- "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy
| | - Leonardo Modesti
- "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy
| | - Giulia Dell'Omo
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Italy
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Italy.
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Abstract
Diabetes mellitus exerts a strong effect on atherosclerotic cardiovascular disease risk into older age (beyond ages 70-74 years). This effect is particularly noticeable with regard to coronary artery disease and cerebral microvascular disease. Thus, diabetes mellitus in older adults deserves the same careful medical attention as it does in middle age.
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Abstract
With respect to clinical phenotype and pathophysiology, prediabetes is akin to diabetes. Prediabetes is prevalent in the global population, and those affected are at high risk of progression to overt diabetes, and also at risk of cardiovascular disease (CVD). Progression to diabetes can occur because of worsening insulin resistance, β-cell dysfunction, or both, but the timecourse can be non-linear and, therefore, unpredictable. Intervention-by lifestyle modification, glucose-lowering drugs, or a combination-can postpone deterioration of glucose control, but effects of intervention are variable and can be transient. Furthermore, to what extent interventions can reduce cardiovascular risk is uncertain. Lifestyle intervention mainly hinges on weight loss; as such, risk of failure in the long-term is high, and implementation at the community level is difficult. The ideal candidate for intervention is an individual with prediabetes-identified by targeted screening-with many well documented cardiovascular risk factors, and who is highly motivated to initiate and maintain multifactorial risk-control using a personalised mix of lifestyle-adaptation and pharmacological treatment.
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Affiliation(s)
- Ele Ferrannini
- Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy.
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42
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The protection of Rhein lysinate to liver in diabetic mice induced by high-fat diet and streptozotocin. Arch Pharm Res 2014; 38:885-92. [DOI: 10.1007/s12272-014-0423-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/10/2014] [Indexed: 12/20/2022]
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43
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Franch-Nadal J, Mata-Cases M, Vinagre I, Patitucci F, Hermosilla E, Casellas A, Bolivar B, Mauricio D. Differences in the Cardiometabolic Control in Type 2 Diabetes according to Gender and the Presence of Cardiovascular Disease: Results from the eControl Study. Int J Endocrinol 2014; 2014:131709. [PMID: 25328520 PMCID: PMC4189942 DOI: 10.1155/2014/131709] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/07/2014] [Indexed: 11/17/2022] Open
Abstract
The objective of this cross-sectional study was to assess differences in the control and treatment of modifiable cardiovascular risk factors (CVRF: HbA1c, blood pressure [BP], LDL-cholesterol, body mass index, and smoking habit) according to gender and the presence of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) in Catalonia, Spain. The study included available data from electronic medical records for a total of 286,791 patients. After controlling for sex, age, diabetes duration, and treatment received, both men and women with prior CVD had worse cardiometabolic control than patients without previous CVD; women with prior CVD had worse overall control of CVRFs than men except for smoking; and women without prior CVD were only better than men at controlling smoking and BP, with no significant differences in glycemic control. Finally, although the proportion of women treated with lipid-lowering medications was similar to (with prior CVD) or even higher (without CVD) than men, LDL-cholesterol levels were remarkably uncontrolled in both women with and women without CVD. The results stress the need to implement measures to better prevent and treat CVRF in the subgroup of diabetic women, specifically with more intensive statin treatment in those with CVD.
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Affiliation(s)
- Josep Franch-Nadal
- Primary Health Care Center Raval, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Catala de la Salut, Avenida Drassanes 17-21, 08001 Barcelona, Spain
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
- *Josep Franch-Nadal: and
| | - Manel Mata-Cases
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
- Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Catala de la Salut, C/Mar s/n, Sant Adrià de Besòs, 08930 Barcelona, Spain
| | - Irene Vinagre
- Department of Endocrinology and Nutrition, Diabetes Unit, Hospital Clinic, University of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
| | - Flor Patitucci
- Primary Health Care Center Raval, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Catala de la Salut, Avenida Drassanes 17-21, 08001 Barcelona, Spain
| | - Eduard Hermosilla
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
| | - Aina Casellas
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
| | - Bonaventura Bolivar
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
| | - Dídac Mauricio
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari de Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Avenida Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain
- Department of Endocrinology & Nutrition, Health Sciences Research Institute and Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916 Badalona, Spain
- *Dídac Mauricio:
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van der Heijden AAWA, Van't Riet E, Bot SDM, Cannegieter SC, Stehouwer CDA, Baan CA, Dekker JM, Nijpels G. Risk of a recurrent cardiovascular event in individuals with type 2 diabetes or intermediate hyperglycemia: the Hoorn Study. Diabetes Care 2013; 36:3498-502. [PMID: 23877981 PMCID: PMC3816885 DOI: 10.2337/dc12-2691] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate risk of a recurrent cardiovascular event and its predictors in a population-based cohort. RESEARCH DESIGN AND METHODS Participants of the Hoorn Study who had experienced a first cardiovascular event after baseline (n = 336) were followed with respect to a recurrent event. Absolute risk of a recurrent event was calculated for individuals with normal glucose metabolism, intermediate hyperglycemia, and type 2 diabetes. Cox regression models were used to investigate which variables, measured before the first vascular event, predicted a recurrent event using the stepwise backward procedure. RESULTS During a median follow-up of 4.1 years, 44% (n = 148) of the population developed a recurrent vascular event. The rate of recurrent events per 100 person-years was 7.2 (95% CI 5.8-8.7) in individuals with normal glucose metabolism, compared with 9.8 (6.6-14.0) in individuals with intermediate hyperglycemia and 12.5 (8.5-17.6) in individuals with type 2 diabetes. Higher age (hazard ratio 1.02 [95% CI 1.00-1.04]), male sex (1.56 [1.08-2.25]), waist circumference (1.02 [1.02-1.03]), higher systolic blood pressure (1.01 [1.01-1.02]), higher HbA1c (%, 1.13 [0.97-1.31]/ mmol/mol, 1.01 [1.00-1.03]), and family history of myocardial infarction (1.38 [0.96-2.00]) predicted a recurrent cardiovascular event. CONCLUSIONS Individuals with type 2 diabetes, but not individuals with intermediate hyperglycemia, are at increased risk for a recurrent vascular event compared with individuals with normal glucose metabolism. In people with a history of cardiovascular disease, people at increased risk of a recurrent event can be identified based on the patient's risk profile before the first event.
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Ahmad Kiadaliri A, Gerdtham UG, Nilsson P, Eliasson B, Gudbjörnsdottir S, Carlsson KS. Towards renewed health economic simulation of type 2 diabetes: risk equations for first and second cardiovascular events from Swedish register data. PLoS One 2013; 8:e62650. [PMID: 23671618 PMCID: PMC3650043 DOI: 10.1371/journal.pone.0062650] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/25/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Predicting the risk of future events is an essential part of health economic simulation models. In pursuit of this goal, the current study aims to predict the risk of developing first and second acute myocardial infarction, heart failure, non-acute ischaemic heart disease, and stroke after diagnosis in patients with type 2 diabetes, using data from the Swedish National Diabetes Register. MATERIAL AND METHODS Register data on 29,034 patients with type 2 diabetes were analysed over five years of follow up (baseline 2003). To develop and validate the risk equations, the sample was randomly divided into training (75%) and test (25%) subsamples. The Weibull proportional hazard model was used to estimate the coefficients of the risk equations, and these were validated in both the training and the test samples. RESULTS In total, 4,547 first and 2,418 second events were observed during the five years of follow up. Experiencing a first event substantially elevated the risk of subsequent events. There were heterogeneities in the effects of covariates within as well as between events; for example, while for females the hazard ratio of having a first acute myocardial infarction was 0.79 (0.70-0.90), the hazard ratio of a second was 1.21 (0.98-1.48). The hazards of second events decreased as the time since first events elapsed. The equations showed adequate calibration and discrimination (C statistics range: 0.70-0.84 in test samples). CONCLUSION The accuracy of health economic simulation models of type 2 diabetes can be improved by ensuring that they account for the heterogeneous effects of covariates on the risk of first and second cardiovascular events. Thus it is important to extend such models by including risk equations for second cardiovascular events.
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Affiliation(s)
- Aliasghar Ahmad Kiadaliri
- Division of Health Economics, Department of Clinical Sciences, Malmö University Hospital, Lund University, Malmö, Sweden.
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46
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Rubin RR, Peyrot M, Gaussoin SA, Espeland MA, Williamson D, Faulconbridge LF, Wadden TA, Ewing L, Safford M, Evans-Hudnall G, Wing RR, Knowler WC. Four-year analysis of cardiovascular disease risk factors, depression symptoms, and antidepressant medicine use in the Look AHEAD (Action for Health in Diabetes) clinical trial of weight loss in diabetes. Diabetes Care 2013; 36:1088-94. [PMID: 23359362 PMCID: PMC3631821 DOI: 10.2337/dc12-1871] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study the association of depressive symptoms or antidepressant medicine (ADM) use with subsequent cardiovascular disease (CVD) risk factor status in the Look AHEAD (Action for Health in Diabetes) trial of weight loss in type 2 diabetes. RESEARCH DESIGN AND METHODS Participants (n = 5,145; age [mean ± SD] 58.7 ± 6.8 years; BMI 35.8 ± 5.8 kg/m(2)) in two study arms (intensive lifestyle [ILI], diabetes support and education [DSE]) completed the Beck Depression Inventory (BDI), reported ADM use, and were assessed for CVD risk factors at baseline and annually for 4 years. Risk factor-positive status was defined as current smoking, obesity, HbA1c >7.0% or insulin use, and blood pressure or cholesterol not at levels recommended by expert consensus panel or medicine to achieve recommended levels. Generalized estimating equations assessed within-study arm relationships of elevated BDI score (≥11) or ADM use with subsequent year CVD risk status, controlled for demographic variables, CVD history, diabetes duration, and prior CVD risk status. RESULTS Prior year elevated BDI was associated with subsequent CVD risk factor-positive status for the DSE arm (A1C [odds ratio 1.30 (95% CI 1.09-1.56)]; total cholesterol [0.80 (0.65-1.00)]; i.e., protective from high total cholesterol) and the ILI arm (HDL [1.40 (1.12-1.75)], triglyceride [1.28 (1.00-1.64)]). Prior year ADM use predicted subsequent elevated CVD risk status for the DSE arm (HDL [1.24 (1.03-1.50)], total cholesterol [1.28 (1.05-1.57)], current smoking [1.73 (1.04-2.88)]) and for the ILI arm (A1C [1.25 (1.08-1.46)], HDL [1.32 (1.11-1.58)], triglycerides [1.75 (1.43-2.14)], systolic blood pressure [1.39 (1.11-1.74)], and obesity [1.46 (1.22-2.18)]). CONCLUSIONS Aggressive monitoring of CVD risk in diabetic patients with depressive symptoms or who are treated with ADM may be warranted.
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Affiliation(s)
- Richard R Rubin
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Modulation of lipoprotein metabolism by antisense technology: preclinical drug discovery methodology. Methods Mol Biol 2013; 1027:309-24. [PMID: 23912993 DOI: 10.1007/978-1-60327-369-5_14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Antisense oligonucleotides (ASOs) are a new class of specific therapeutic agents that alter the intermediary metabolism of mRNA, resulting in the suppression of disease-associated gene products. ASOs exert their pharmacological effects after hybridizing, via Watson-Crick base pairing, to a specific target RNA. If appropriately designed, this event results in the recruitment of RNase H, the degradation of targeted mRNA or pre-mRNA, and subsequent inhibition of the synthesis of a specific protein. A key advantage of the technology is the ability to selectively inhibit targets that cannot be modulated by traditional therapeutics such as structural proteins, transcription factors, and, of topical interest, lipoproteins. In this chapter, we will first provide an overview of antisense technology, then more specifically describe the status of lipoprotein-related genes that have been studied using the antisense platform, and finally, outline the general methodology required to design and evaluate the in vitro and in vivo efficacy of those drugs.
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48
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Simmons RK, Sharp SJ, Sandbæk A, Borch-Johnsen K, Davies MJ, Khunti K, Lauritzen T, Rutten GEHM, van den Donk M, Wareham NJ, Griffin SJ. Does early intensive multifactorial treatment reduce total cardiovascular burden in individuals with screen-detected diabetes? Findings from the ADDITION-Europe cluster-randomized trial. Diabet Med 2012; 29:e409-16. [PMID: 22823477 PMCID: PMC3698698 DOI: 10.1111/j.1464-5491.2012.03759.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 10/28/2022]
Abstract
AIMS To describe the total cardiovascular burden (cardiovascular morbidity or mortality, revascularization or non-traumatic amputation) in individuals with screen-detected diabetes in the ADDITION-Europe trial and to quantify the impact of the intervention on multiple cardiovascular events over 5 years. METHODS In a pragmatic, cluster-randomized, parallel-group trial in four centres (Denmark; Cambridge, UK; the Netherlands; and Leicester, UK), 343 general practices were randomized to screening plus routine care (n = 1379 patients), or screening and promotion of target-driven, intensive treatment of multiple risk factors (n = 1678). We estimated the effect of the intervention on multiple cardiovascular events after diagnosis of diabetes using the Wei, Lin and Weissfeld method. RESULTS Over 5.3 years, 167 individuals had exactly one cardiovascular event, 53 exactly two events, and 18 three or more events. The incidence rates (95% CI) of first events and any event per 1000 person-years were 14.6 (12.8-16.6) and 20.4 (18.2-22.6), respectively. There were non-significant reductions in the risk of a first (hazard ratio 0.83, 95% CI 0.65-1.05) and second primary endpoint (hazard ratio 0.70, 95% CI 0.43-1.12). The overall average hazard ratio for any event was 0.77 (95% CI 0.58-1.02). CONCLUSIONS Early intensive multifactorial treatment was not associated with a significant reduction in total cardiovascular burden at 5 years. Focusing on first events in cardiovascular disease prevention trials underestimates the total cardiovascular burden to patients and the health service.
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49
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Abstract
High blood pressure is reported in over two-thirds of patients with type 2 diabetes, and its development coincides with the development of hyperglycaemia. Many pathophysiological mechanisms underlie this association. Of these mechanisms, insulin resistance in the nitric-oxide pathway; the stimulatory effect of hyperinsulinaemia on sympathetic drive, smooth muscle growth, and sodium-fluid retention; and the excitatory effect of hyperglycaemia on the renin-angiotensin-aldosterone system seem to be plausible. In patients with diabetes, hypertension confers an enhanced risk of cardiovascular disease. A blood pressure of lower than 140/85 mm Hg is a reasonable therapeutic goal in patients with type 2 diabetes according to clinical trial evidence. People with controlled diabetes have a similar cardiovascular risk to patients without diabetes but with hypertension. A renin-angiotensin system blocker combined with a thiazide-type diuretic might be the best initial antihypertensive regimen for most people with diabetes. In general, the positive effects of antihypertensive drugs on cardiovascular outcomes outweigh the negative effects of antihypertensive drugs on glucose metabolism.
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Affiliation(s)
- Ele Ferrannini
- Department of Internal Medicine, University of Pisa, Pisa, Italy.
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50
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Weinheimer EM, Conley TB, Kobza VM, Sands LP, Lim E, Janle EM, Campbell WW. Whey protein supplementation does not affect exercise training-induced changes in body composition and indices of metabolic syndrome in middle-aged overweight and obese adults. J Nutr 2012; 142:1532-9. [PMID: 22718030 PMCID: PMC3397339 DOI: 10.3945/jn.111.153619] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Little is known about the effects of different quantities of whey protein on exercise training-induced changes in body composition and indices of metabolic syndrome in middle-aged overweight and obese adults. Therefore, we examined the effects of consuming 0.8-MJ supplements with 0 (n = 126), 10 (n = 112), 20 (n = 44), or 30 (n = 45) g whey protein twice daily in conjunction with resistance (2 d/wk) and aerobic (1 d/wk) exercise training in a double-blind, randomized, placebo-controlled, community-based 9-mo study in men (n = 117) and women (n = 210); (age: 48 ± 7.9 y; BMI: 30.0 ± 2.8 kg/m(2)). Whey protein supplementation did not influence any of the following outcomes, some of which were affected by training. Among all participants, strength increased by 15 ± 12% (P < 0.001) and maximal oxygen uptake capacity (VO(2)max) increased by 9 ± 15% (P < 0.001). Body weight was unchanged (0.1 ± 3.7 kg, P = 0.80), lean body mass increased by 1.9 ± 2.8% (0.95 ± 1.3 kg, P < 0.001), and fat mass decreased by 2.6 ± 9.4% (-0.86 ± 3.1 kg, P = 0.001). Oral-glucose-tolerance testing showed that plasma glucose AUC was unchanged (-18.0 ± 170 mmol/L· 3 h, P = 0.16), insulin AUC decreased by 2.6 ± 32% (-7.5 ± 29 nmol/L· 3 h, P = 0.01), and HOMA-IR (0.2 ± 2.0, P = 0.81) and the insulin sensitivity index (0.3 ± 3.0, P = 0.63) were unchanged. Plasma concentrations of TG; total, LDL, and HDL cholesterol; C-reactive protein; plasminogen activator inhibitor-1; blood pressure; and waist circumference were unchanged. Whey protein supplementation did not affect exercise training-induced responses in body composition and indices of metabolic syndrome in middle-aged overweight and obese adults who maintained body weight.
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Affiliation(s)
| | - Travis B. Conley
- Department of Nutrition Science,Ingestive Behavior Research Center
| | | | - Laura P. Sands
- Center on Aging and the Life Course,Ingestive Behavior Research Center,School of Nursing, and
| | - Eunjung Lim
- Department of Statistics, Purdue University, West Lafayette, IN
| | | | - Wayne W. Campbell
- Department of Nutrition Science,Center on Aging and the Life Course,Ingestive Behavior Research Center,To whom correspondence should be addressed. E-mail:
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