1
|
McCarthy MM, Fletcher J, Wright F, Del Giudice I, Wong A, Aouizerat BE, Vaughan Dickson V, Melkus GD. Factors Associated With the Cardiovascular Health of Black and Latino Adults With Type 2 Diabetes. Biol Res Nurs 2024; 26:438-448. [PMID: 38448370 DOI: 10.1177/10998004241238237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
AIMS The purpose of this study was to assess the levels of cardiovascular health (CVH) of Black and Latino adults with type 2 diabetes (T2D) and examine the association of individual and microsystem level factors with their CVH score. METHODS This was a cross-sectional design in 60 Black and Latino Adults aged 18-40 with T2D. Data were collected on sociodemographic, individual (sociodemographic, diabetes self-management, sleep disturbance, depressive symptoms, quality of life, and the inflammatory biomarkers IL-6 and hs-CRP) and microsystem factors (family functioning), and American Heart Association's Life's Simple 7 metrics of CVH. Factors significantly associated with the CVH score in the bivariate analyses were entered into a linear regression model. RESULTS The sample had a mean age 34 ± 5 years and was primarily female (75%) with a mean CVH score was 8.6 ± 2.2 (possible range of 0-14). The sample achieved these CVH factors at ideal levels: body mass index <25 kg/m2 (8%); blood pressure <120/80 (42%); hemoglobin A1c < 7% (57%); total cholesterol <200 mg/dL (83%); healthy diet (18%); never or former smoker > one year (95%); and physical activity (150 moderate-to-vigorous minutes/week; 45%). In the multivariable model, two factors were significantly associated with cardiovascular health: hs-CRP (B = -0.11621, p < .0001) and the general health scale (B = 0.45127, p = .0013). CONCLUSIONS This sample had an intermediate level of CVH, with inflammation and general health associated with overall CVH score.
Collapse
Affiliation(s)
| | - Jason Fletcher
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Inés Del Giudice
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Agnes Wong
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | | | | |
Collapse
|
2
|
Mellor J, Jeyam A, Beulens JW, Bhandari S, Broadhead G, Chew E, Fickweiler W, van der Heijden A, Gordin D, Simó R, Snell-Bergeon J, Tynjälä A, Colhoun H. Role of Systemic Factors in Improving the Prognosis of Diabetic Retinal Disease and Predicting Response to Diabetic Retinopathy Treatment. OPHTHALMOLOGY SCIENCE 2024; 4:100494. [PMID: 38694495 PMCID: PMC11061755 DOI: 10.1016/j.xops.2024.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 05/04/2024]
Abstract
Topic To review clinical evidence on systemic factors that might be relevant to update diabetic retinal disease (DRD) staging systems, including prediction of DRD onset, progression, and response to treatment. Clinical relevance Systemic factors may improve new staging systems for DRD to better assess risk of disease worsening and predict response to therapy. Methods The Systemic Health Working Group of the Mary Tyler Moore Vision Initiative reviewed systemic factors individually and in multivariate models for prediction of DRD onset or progression (i.e., prognosis) or response to treatments (prediction). Results There was consistent evidence for associations of longer diabetes duration, higher glycosylated hemoglobin (HbA1c), and male sex with DRD onset and progression. There is strong trial evidence for the effect of reducing HbA1c and reducing DRD progression. There is strong evidence that higher blood pressure (BP) is a risk factor for DRD incidence and for progression. Pregnancy has been consistently reported to be associated with worsening of DRD but recent studies reflecting modern care standards are lacking. In studies examining multivariate prognostic models of DRD onset, HbA1c and diabetes duration were consistently retained as significant predictors of DRD onset. There was evidence of associations of BP and sex with DRD onset. In multivariate prognostic models examining DRD progression, retinal measures were consistently found to be a significant predictor of DRD with little evidence of any useful marginal increment in prognostic information with the inclusion of systemic risk factor data apart from retinal image data in multivariate models. For predicting the impact of treatment, although there are small studies that quantify prognostic information based on imaging data alone or systemic factors alone, there are currently no large studies that quantify marginal prognostic information within a multivariate model, including both imaging and systemic factors. Conclusion With standard imaging techniques and ways of processing images rapidly evolving, an international network of centers is needed to routinely capture systemic health factors simultaneously to retinal images so that gains in prediction increment may be precisely quantified to determine the usefulness of various health factors in the prognosis of DRD and prediction of response to treatment. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Joe Mellor
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Anita Jeyam
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Crewe Road, Edinburgh, Scotland
| | - Joline W.J. Beulens
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Sanjeeb Bhandari
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Geoffrey Broadhead
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Ward Fickweiler
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Amber van der Heijden
- Department of General Practice, Amsterdam Public Health Institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Department of Nephrology, Helsinki University Hospital, University of Helsinki, Finland
| | - Rafael Simó
- Endocrinology & Nutrition, Institut de Recerca Hospital Universitari Vall d’Hebron (VHIR), Barcelona, Spain
| | - Janet Snell-Bergeon
- Clinical Epidemiology Division, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Colorado
| | - Anniina Tynjälä
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Department of Nephrology, Helsinki University Hospital, University of Helsinki, Finland
| | - Helen Colhoun
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Crewe Road, Edinburgh, Scotland
| |
Collapse
|
3
|
Kaur G, Mason RP, Steg PG, Bhatt DL. Omega-3 fatty acids for cardiovascular event lowering. Eur J Prev Cardiol 2024; 31:1005-1014. [PMID: 38169319 DOI: 10.1093/eurjpc/zwae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/05/2024]
Abstract
Low-density lipoprotein cholesterol (LDL-C) is the main target for therapeutics aimed at reducing the risk of atherosclerotic cardiovascular disease (ASCVD) and downstream cardiovascular (CV) events. However, multiple studies have demonstrated that high-risk patient populations harbour residual risk despite effective LDL-C lowering. While data support the causal relationship between triglycerides and ASCVD risk, triglyceride-lowering therapies such as omega-3 fatty acids have shown mixed results in CV outcomes trials. Notably, icosapent ethyl, a purified formulation of eicosapentaenoic acid (EPA), has garnered compelling evidence in lowering residual CV risk in patients with hypertriglyceridaemia and treated with statins. In this review, we summarize studies that have investigated omega-3-fatty acids for CV event lowering and discuss the clinical implementation of these agents based on trial data and guidelines.
Collapse
Affiliation(s)
- Gurleen Kaur
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R Preston Mason
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Elucida Research LLC, Beverly, MA, USA
| | - Ph Gabriel Steg
- Paris Cité University, Public Hospitals of Paris (AP-HP), Bichat Hospital, Paris, France
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
4
|
Kario K, Hoshide S, Yamamoto K, Okura A, Rakugi H. Clinical studies on pharmacological treatment of hypertension in Japan. J Hum Hypertens 2024; 38:486-499. [PMID: 33963269 DOI: 10.1038/s41371-021-00533-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 12/16/2022]
Abstract
Differences in the epidemiology and phenotypes of hypertension in Japan compared with Western countries mean that optimal approaches to the pharmacological management of hypertension should be based on local data. Fortunately, there is a large body of evidence from studies conducted in Japanese populations to inform guidelines and treatment decisions. This article highlights treatment recommendations and BP targets for Japanese patients with hypertension, and summarizes key literature supporting these recommendations. The latest version of the Japanese Society of Hypertension (JSH) guidelines is consistent with US and European guidelines in recommending that the general BP target should be <130/80 mmHg for office blood pressure (BP) and <125/75 mmHg for home BP. There is good local evidence to support these targets. The JSH guidelines also strongly recommend that antihypertensive therapy is managed and monitored based on home BP, due to the closer association of this parameter with cardiovascular risk compared with office BP. Japan is a leader in out-of-office BP research, meaning that there is good evidence for the Japanese recommendations. Key features of antihypertensive agents for use in Japanese patients with hypertension include the ability to reduce stroke risk provide antihypertensive efficacy throughout the 24-h dosing period. Calcium channel blockers appear to be particularly effective in Asian populations, and are the most commonly prescribed agents in Japan. Again consistent with international recommendations, antihypertensive therapy should be started with a combination of agents to maximize the chances of achieving target BP.
Collapse
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Koichi Yamamoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ayako Okura
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|
5
|
Zaninotto P, Steptoe A, Shim EJ. CVD incidence and mortality among people with diabetes and/or hypertension: Results from the English longitudinal study of ageing. PLoS One 2024; 19:e0303306. [PMID: 38820248 PMCID: PMC11142434 DOI: 10.1371/journal.pone.0303306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 04/23/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND AND AIMS Diabetes and/or hypertension are the most common conditions in older people, and also related to higher cardiovascular disease (CVD) incidence and mortality. This study aims to explore the risk of CVD incidence and mortality among older people with diabetes and/or hypertension over a 16 years follow-up period and investigates the role of depression and obesity in these relationships. METHODS 6,855 participants aged 50+ from the English Longitudinal Study of Ageing (ELSA). The main exposure is having diabetes and/or hypertension at baseline (2002/2003) compared to not having, but excluded those with coronary heart disease (CHD) and/or stroke (CVD). Survival models are used for CVD incidence and mortality up to 2018, adjusted for socio-demographic, health, health behaviours, cognitive function, and physical function characteristics. RESULTS 39.3% of people at baseline had diabetes and/or hypertension. The risk of CVD incidence was 1.7 (95%CI: 1.5; 1.9) higher among people with diabetes and/or hypertension compared to those without and was independent of covariates adjustment. People with diabetes and/or hypertension were also 1.3 (95%CI: 1.1; 1.8) times more likely to die from CVD than those without. We did not find evidence for an elevated risk of CVD incidence and mortality among people with obesity nor among those with depression. CONCLUSIONS In order to effectively reduce the risk of CVD incidence and mortality among older people, treatment as well as management of hypertension and diabetes should be routinely considered for older people with diabetes and/or hypertension.
Collapse
Affiliation(s)
- Paola Zaninotto
- Department of Epidemiology and Public Health, UCL, London, United Kingdom
| | - Andrew Steptoe
- Department of Behavioural Science and Health, UCL, London, United Kingdom
| | - Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| |
Collapse
|
6
|
Surawit A, Pongkunakorn T, Manosan T, Mongkolsucharitkul P, Chamnan P, Suvarnabhumi K, Puangpet T, Suta S, Pumeiam S, Pinsawas B, Ophakas S, Pisitpornsuk S, Utchin C, Mayurasakorn K. Factors influencing optimal diabetes care and clinical outcomes in Thai patients with type 2 diabetes mellitus: a multilevel modelling analysis. BMJ Open 2024; 14:e079415. [PMID: 38702083 PMCID: PMC11086275 DOI: 10.1136/bmjopen-2023-079415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Increasing levels of poor glycaemic control among Thai patients with type 2 diabetes mellitus (T2DM) motivated us to compare T2DM care between urban and suburban primary care units (PCUs), to identify gaps in care, and to identify significant factors that may influence strategies to enhance the quality of care and clinical outcomes in this population. METHODS We conducted a cross-sectional study involving 2160 patients with T2DM treated at four Thai PCUs from 2019 to 2021, comprising one urban and three suburban facilities. Using mixed effects logistic regression, we compared care factors between urban and suburban PCUs. RESULTS Patients attending suburban PCUs were significantly more likely to undergo eye (adjusted OR (AOR): 1.83, 95% CI 1.35 to 1.72), foot (AOR: 1.61, 95% CI 0.65 to 4.59) and HbA1c (AOR: 1.66, 95% CI 1.09 to 2.30) exams and achieved all ABC (HbA1c, blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C)) goals (AOR: 2.23, 95% CI 1.30 to 3.83). Conversely, those at an urban PCU were more likely to undergo albuminuria exams. Variables significantly associated with good glycaemic control included age (AOR: 1.51, 95% CI 1.31 to 1.79), T2DM duration (AOR: 0.59, 95% CI 0.41 to 0.88), FAACE (foot, HbA1c, albuminuria, LDL-C and eye) goals (AOR: 1.23, 95% CI 1.12 to 1.36) and All8Q (AOR: 1.20, 95% CI 1.05 to 1.41). Chronic kidney disease (CKD) was significantly linked with high triglyceride and HbA1c levels (AOR: 5.23, 95% CI 1.21 to 7.61). Elevated HbA1c levels, longer T2DM duration, insulin use, high systolic BP and high lipid profile levels correlated strongly with diabetic retinopathy (DR) and CKD progression. CONCLUSION This highlights the necessity for targeted interventions to bridge urban-suburban care gaps, optimise drug prescriptions and implement comprehensive care strategies for improved glycaemic control, DR prevention and CKD progression mitigation among in Thai patients with T2DM. The value of the clinical target aggregate (ABC) and the process of care aggregate (FAACE) was also conclusively demonstrated.
Collapse
Affiliation(s)
- Apinya Surawit
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyaporn Pongkunakorn
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thamonwan Manosan
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pichanun Mongkolsucharitkul
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Parinya Chamnan
- Department of Social Medicine, Sunpasithiprasong Hospital, Ubon Ratchathani, Thailand
| | - Krishna Suvarnabhumi
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Thanapat Puangpet
- Department of Social Medicine, Samutsakhon Hospital, Samut Sakhon, Thailand
| | - Sophida Suta
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sureeporn Pumeiam
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bonggochpass Pinsawas
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suphawan Ophakas
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sananon Pisitpornsuk
- Division of Nursing, Siriraj Primary Care Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalita Utchin
- Division of Nursing, Siriraj Primary Care Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Korapat Mayurasakorn
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
7
|
Lin CC, Li CI, Liu CS, Lin CH, Yang SY, Li TC. Association of carotid atherosclerosis markers with all-cause and cardiovascular disease-specific mortality in persons with type 2 diabetes: a causal mediation analysis with glucose variation. Acta Diabetol 2024; 61:657-669. [PMID: 38393346 DOI: 10.1007/s00592-024-02243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
AIMS Glucose variation (GV) is independently associated with mortality in patients with diabetes. However, no study has examined the effects of carotid atherosclerosis markers on mortality after considering GV. Our purpose is to investigate the independent effects of carotid atherosclerosis markers in persons with type 2 diabetes (T2DM) after considering GV and the mediation effects of carotid atherosclerosis markers on associations between GV with cardiovascular disease (CVD) mortality. MATERIALS AND METHODS This study is a retrospective cohort study including 3628 persons with T2DM who were admitted to a medical center between January 01, 2001 and October 31, 2021. GV was defined as a coefficient of variation (CV) of repeated measurements within a year before the index date (date of first IMT assessment). Carotid atherosclerosis markers included intima-media thickness (IMT), plaque, and stenosis. The outcomes consisted of all-cause and expanded cardiovascular disease (CVD) mortality. Cox proportional hazards models were applied. RESULTS Among the participants, 286 (7.9%) had IMT ≥ 2 mm, 2834 (78.1%) had carotid plaque, and 464 (12.8%) had carotid stenosis ≥ 50%. When GV was considered, IMT, carotid plaque, and carotid stenosis were significant factors for all-cause mortality (except IMT considering HbA1c-CV) and expanded CVD mortality. IMT was a significant mediator in the associations of fasting plasma glucose (FPG)-CV with all-cause and expanded CVD mortality (2 and 3.19%, respectively), and carotid stenosis was a significant mediator in the association between FPG-CV and expanded CVD mortality (3.83%). CONCLUSIONS Our statistical evaluations show suggests that carotid atherosclerosis markers are important predictors of CVD mortality in persons with T2DM if GV is considered. In addition, IMT and carotid stenosis were significant mediators in the association between GV and mortality.
Collapse
Affiliation(s)
- Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, R.O.C
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, R.O.C
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, R.O.C
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, R.O.C
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., 406040, Taichung, Taiwan, R.O.C
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., 406040, Taichung, Taiwan, R.O.C..
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan, R.O.C..
| |
Collapse
|
8
|
Cai QY, Tang J, Meng SZ, Sun Y, Lan X, Liu TH. Quality assessment of videos on social media platforms related to gestational diabetes mellitus in China: A cross-section study. Heliyon 2024; 10:e29020. [PMID: 38617917 PMCID: PMC11015130 DOI: 10.1016/j.heliyon.2024.e29020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose This study aimed to systematically evaluate the quality of content and information in videos related to gestational diabetes mellitus on Chinese social media platforms. Methods The videos on various platforms, TikTok, Bilibili, and Weibo, were searched with the keyword "gestational diabetes mellitus" in Chinese, and the first 50 videos with a comprehensive ranking on each platform were included for subsequent analysis. Characteristic information of video was collected, such as their duration, number of days online, number of likes, comments, and number of shares. DISCREN, JAMA (The Journal of the American Medical Association) Benchmark Criteria, and GQS (Global Quality Scores) were used to assess the quality of all videos. Finally, the correlation analysis was performed among video features, video sources, DISCERN scores, and JAMA scores. Results Ultimately, 135 videos were included in this study. The mean DISCERN total score was 31.84 ± 7.85, the mean JAMA score was 2.33 ± 0.72, and the mean GQS was 2.00 ± 0.40. Most of the videos (52.6%) were uploaded by independent medical professionals, and videos uploaded by professionals had the shortest duration and time online (P < 0.001). The source of the video was associated with numbers of "likes", "comments", and "shares" for JAMA scores (P < 0.001), but there was no correlation with DISCERN scores. Generally, videos on TikTok with the shortest duration received the most numbers of "likes", "comments", and "shares", but the overall quality of videos on Weibo was higher. Conclusion Although the majority of the videos were uploaded by independent medical professionals, the overall quality appeared to be poor. Therefore, more efforts and actions should be taken to improve the quality of videos related to gestational diabetes mellitus.
Collapse
Affiliation(s)
- Qin-Yu Cai
- The Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, 400016, China
- Department of Bioinformatics, The School of Basic Medicine, Chongqing Medical University, No.1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016, China
| | - Jing Tang
- The Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, 400016, China
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, 400037, China
| | - Si-Zhe Meng
- The Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, 400016, China
- Department of Bioinformatics, The School of Basic Medicine, Chongqing Medical University, No.1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016, China
| | - Yi Sun
- The Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, 400016, China
- Department of Bioinformatics, The School of Basic Medicine, Chongqing Medical University, No.1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016, China
| | - Xia Lan
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, 400037, China
| | - Tai-Hang Liu
- The Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, 400016, China
- Department of Bioinformatics, The School of Basic Medicine, Chongqing Medical University, No.1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016, China
| |
Collapse
|
9
|
Hu Y, Velu P, Rohani P, Sohouli MH. Changes in lipid profile and glucose metabolism following administration of bupropion alone or in combination with naltrexone: A systematic review and meta-regression analysis. Eur J Clin Invest 2024; 54:e14122. [PMID: 37929909 DOI: 10.1111/eci.14122] [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: 07/13/2023] [Revised: 09/29/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Considering the conflicting effects of bupropion on parameters related to metabolic syndrome including glucose metabolism and lipid profile, in this meta-analysis study, we investigated the effects of this drug alone or in combination with naltrexone on glucose metabolism and lipid profile. METHODS Scopus, PubMed/Medline, Web of Science and Embase databases were searched using standard keywords to identify all controlled trials investigating effects of bupropion alone and combined with naltrexone on the glucose and lipid profile. Pooled weighted mean difference and 95% confidence intervals were achieved by random-effects model. RESULTS Twelve studies with 5152 participants' were included in this article. The pooled findings showed that bupropion alone or in combination with naltrexone would significantly reduce glucose (weighted mean difference (WMD): -2.25 mg/dL, 95% confidence interval (CI): -4.10, -0.40), insulin (WMD: -4.06 μU/mL, 95% CI: -6.09, -2.03), homeostatic model assessment for insulin resistance (HOMA-IR) (WMD: -0.58, 95% CI: -0.98, -0.19), triglyceride (TG) (WMD: -11.78 mg/dL, 95% CI: -14.48 to -9.08) and increase high-density lipoprotein (HDL) (WMD: 2.68 mg/dL, 95% CI: 2.13 to 3.24). A Greater reduction in glucose levels was observed with duration >26 weeks. Dose of bupropion intake ≤360 mg and intervention for more than 26 weeks decreased insulin level significantly. With regard to lipid profile, reduction of triglycerides is more significant with dose of bupropion greater than 360 mg and a shorter intervention length equal to 26 weeks. CONCLUSIONS The addition of combination therapies such as bupropion and naltrexone to lifestyle modification can significantly improve glucose metabolism and some lipid parameters.
Collapse
Affiliation(s)
- Yi Hu
- School of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Periyannan Velu
- Galileovasan Offshore and Research and Development Pvt. Ltd., Nagapattinam, Tamil Nadu, India
| | - Pejman Rohani
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Sohouli
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Qian B, Chen H, Wang X, Guan Z, Li T, Jin Y, Wu Y, Wen Y, Che H, Kwon G, Kim J, Choi S, Shin S, Krause F, Unterdechler M, Hou J, Feng R, Li Y, El Habib Daho M, Yang D, Wu Q, Zhang P, Yang X, Cai Y, Tan GSW, Cheung CY, Jia W, Li H, Tham YC, Wong TY, Sheng B. DRAC 2022: A public benchmark for diabetic retinopathy analysis on ultra-wide optical coherence tomography angiography images. PATTERNS (NEW YORK, N.Y.) 2024; 5:100929. [PMID: 38487802 PMCID: PMC10935505 DOI: 10.1016/j.patter.2024.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024]
Abstract
We described a challenge named "DRAC - Diabetic Retinopathy Analysis Challenge" in conjunction with the 25th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2022). Within this challenge, we provided the DRAC datset, an ultra-wide optical coherence tomography angiography (UW-OCTA) dataset (1,103 images), addressing three primary clinical tasks: diabetic retinopathy (DR) lesion segmentation, image quality assessment, and DR grading. The scientific community responded positively to the challenge, with 11, 12, and 13 teams submitting different solutions for these three tasks, respectively. This paper presents a concise summary and analysis of the top-performing solutions and results across all challenge tasks. These solutions could provide practical guidance for developing accurate classification and segmentation models for image quality assessment and DR diagnosis using UW-OCTA images, potentially improving the diagnostic capabilities of healthcare professionals. The dataset has been released to support the development of computer-aided diagnostic systems for DR evaluation.
Collapse
Affiliation(s)
- Bo Qian
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
| | - Xiangning Wang
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Zhouyu Guan
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Tingyao Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yixiao Jin
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
| | - Yilan Wu
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
| | - Yang Wen
- School of Electronic and Information Engineering, Shenzhen University, Shenzhen 518060, China
| | - Haoxuan Che
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
| | | | | | - Sungjin Choi
- AI/DX Convergence Business Group, KT, Seongnam 13606, Korea
| | - Seoyoung Shin
- AI/DX Convergence Business Group, KT, Seongnam 13606, Korea
| | - Felix Krause
- Johannes Kepler University Linz, Linz 4040, Austria
| | | | - Junlin Hou
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai 200433, China
| | - Rui Feng
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai 200433, China
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Yihao Li
- LaTIM UMR 1101, INSERM, 29609 Brest, France
- University of Western Brittany, 29238 Brest, France
| | - Mostafa El Habib Daho
- LaTIM UMR 1101, INSERM, 29609 Brest, France
- University of Western Brittany, 29238 Brest, France
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Qiang Wu
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Ping Zhang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Xiaokang Yang
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yiyu Cai
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Weiping Jia
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Huating Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Centre for Innovation and Precision Eye Health; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Bin Sheng
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| |
Collapse
|
11
|
Gao J, Li Y, Zhang Y, Zhan X, Tian X, Li J, Wang R, He Y, Wang A, Wu S. Severity and Remission of Metabolic Dysfunction-Associated Fatty/Steatotic Liver Disease With Chronic Kidney Disease Occurrence. J Am Heart Assoc 2024; 13:e032604. [PMID: 38390843 PMCID: PMC10944048 DOI: 10.1161/jaha.123.032604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The association of the severity of hepatic steatosis in metabolic dysfunction-associated fatty liver disease (MAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) and the remission of MAFLD/MASLD with CKD occurrence is unclear. METHODS AND RESULTS The study enrolled 79 540 participants from the Kailuan cohort. Hepatic steatosis was diagnosed by ultrasound. MAFLD/MASLD was defined as hepatic steatosis combined with metabolic dysfunction and MASLD further excluded alcohol or other causes of liver disease. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate<60 mL/min per 1.73 m2 or positive proteinuria (≥1+). Hazard ratio (HR) was calculated by Cox regression models. After a median follow-up of 12.9 years, CKD occurred in 20 465 participants. After adjusting for potential confounders, MAFLD was associated with a higher risk of CKD compared with non-MAFLD (HR, 1.12 [95% CI, 1.09-1.16]), and this risk increased with increasing severity of hepatic steatosis (P-trend<0.001). Consistent findings were observed when MASLD was used as the exposure. Compared with persistent non-MAFLD, no statistical difference was found in the risk of CKD in MAFLD remission (HR, 1.04 [95% CI, 0.95-1.15]); however, MASLD remission still had a higher risk of CKD compared with persistent non-MASLD (HR, 1.15 [95% CI, 1.03-1.27]). When grouped according to the prior severity of hepatic steatosis, there was no statistically significant difference in risk of CKD in mild-MAFLD/MASLD remission compared with persistent non-MAFLD/MASLD, but moderated/severe-MAFLD/MASLD remission still had a higher risk. CONCLUSIONS The risk of CKD in patients with MAFLD/MASLD increased with the severity of hepatic steatosis. Even after remission of the disease, patients with MAFLD/MASLD with prior moderate to severe hepatic steatosis still had a higher risk of CKD.
Collapse
Affiliation(s)
- Jingli Gao
- Department of Intensive Care UnitKailuan General HospitalTangshanChina
| | - Yuhao Li
- Department of Epidemiology and Health Statistics, School of Public HealthCapital Medical UniversityBeijingChina
- Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Yijun Zhang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Department of Clinical Epidemiology and Clinical TrialCapital Medical UniversityBeijingChina
| | - Xin Zhan
- School of Public HealthThe University of SydneySydneyAustralia
| | - Xue Tian
- Department of Epidemiology and Health Statistics, School of Public HealthCapital Medical UniversityBeijingChina
- Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Junjuan Li
- Department of CardiologyKailuan General HospitalTangshanChina
| | - Ru Wang
- Department of CardiologyKailuan General HospitalTangshanChina
| | - Yan He
- Department of Epidemiology and Health Statistics, School of Public HealthCapital Medical UniversityBeijingChina
- Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Anxin Wang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Department of Clinical Epidemiology and Clinical TrialCapital Medical UniversityBeijingChina
| | - Shouling Wu
- Department of CardiologyKailuan General HospitalTangshanChina
| |
Collapse
|
12
|
Sabbour H, Bhatt DL, Elhenawi Y, Aljaberi A, Bennani L, Fiad T, Hasan K, Hashmani S, Hijazi RA, Khan Z, Shantouf R. A Practical Approach to the Management of Residual Cardiovascular Risk: United Arab Emirates Expert Consensus Panel on the Evidence for Icosapent Ethyl and Omega-3 Fatty Acids. Cardiovasc Drugs Ther 2024:10.1007/s10557-023-07519-z. [PMID: 38363478 DOI: 10.1007/s10557-023-07519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 02/17/2024]
Abstract
PURPOSE Patients with hyperlipidemia treated with statins remain at a residual cardiovascular (CV) risk. Omega-3 polyunsaturated fatty acids hold the potential to mitigate the residual CV risk in statin-treated patients, with persistently elevated triglyceride (TG) levels. METHOD We reviewed the current evidence on the use of icosapent ethyl (IPE), an omega-3 fatty acid yielding a pure form of eicosapentaenoic acid. RESULTS REDUCE-IT reported a significant 25% reduction in CV events, including the need for coronary revascularization, the risk of fatal/nonfatal myocardial infarction, stroke, hospitalization for unstable angina, and CV death in patients on IPE, unseen with other omega-3 fatty acids treatments. IPE was effective in all patients regardless of baseline CV risk enhancers (TG levels, type-2 diabetes status, weight status, prior revascularization, or renal function). Adverse events (atrial fibrillation/flutter) related to IPE have occurred mostly in patients with prior atrial fibrillation. Yet, the net clinical benefit largely exceeded potential risks. The combination with other omega-3 polyunsaturated fatty acids, in particular DHA, eliminated the effect of EPA alone, as reported in the STRENGTH and OMEMI trials. Adding IPE to statin treatment seems to be cost-effective, especially in the context of secondary prevention of CVD, decreasing CV event frequency and subsequently the use of healthcare resources. CONCLUSION Importantly, IPE has been endorsed by 20 international medical societies as a statin add-on treatment in patients with dyslipidemia and high CV risk. Robust medical evidence supports IPE as a pillar in the management of dyslipidemia.
Collapse
Affiliation(s)
- Hani Sabbour
- Warren Alpert School of Medicine, Brown University, RI USA, Mediclinic Hospital, Abu Dhabi, United Arab Emirates.
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Yaser Elhenawi
- Heart And Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Asma Aljaberi
- Endocrine Division, Department of Medicine, Tawam Hospital, Abu Dhabi, United Arab Emirates
| | - Layal Bennani
- Medical Affairs, Biologix, Dubai, United Arab Emirates
| | - Tarek Fiad
- Centre Abu Dhabi, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Khwaja Hasan
- Packer Hospital Guthrie, Sayre, Pennsylvania, USA
| | - Shahrukh Hashmani
- Heart And Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Rabih A Hijazi
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Zafar Khan
- Department of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ronney Shantouf
- Heart And Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| |
Collapse
|
13
|
Alsan M, Durvasula M, Gupta H, Schwartzstein J, Williams H. REPRESENTATION AND EXTRAPOLATION: EVIDENCE FROM CLINICAL TRIALS . THE QUARTERLY JOURNAL OF ECONOMICS 2024; 139:575-635. [PMID: 38859982 PMCID: PMC11164133 DOI: 10.1093/qje/qjad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
This article examines the consequences and causes of low enrollment of Black patients in clinical trials. We develop a simple model of similarity-based extrapolation that predicts that evidence is more relevant for decision-making by physicians and patients when it is more representative of the group being treated. This generates the key result that the perceived benefit of a medicine for a group depends not only on the average benefit from a trial but also on the share of patients from that group who were enrolled in the trial. In survey experiments, we find that physicians who care for Black patients are more willing to prescribe drugs tested in representative samples, an effect substantial enough to close observed gaps in the prescribing rates of new medicines. Black patients update more on drug efficacy when the sample that the drug is tested on is more representative, reducing Black-white patient gaps in beliefs about whether the drug will work as described. Despite these benefits of representative data, our framework and evidence suggest that those who have benefited more from past medical breakthroughs are less costly to enroll in the present, leading to persistence in who is represented in the evidence base.
Collapse
Affiliation(s)
- Marcella Alsan
- Harvard Kennedy School and National Bureau of Economic Research, United States
| | | | | | | | - Heidi Williams
- Stanford University and National Bureau of Economic Research, United States
| |
Collapse
|
14
|
Wu S, Li Y, Zhang Y, Su X, Zuo Y, Chen G, Xu G, Chen S, He Y, Wang A. Sex and Age Differences in the Association Between Metabolic Dysfunction-Associated Fatty Liver Disease and Heart Failure: A Prospective Cohort Study. Circ Heart Fail 2024; 17:e010841. [PMID: 38348678 DOI: 10.1161/circheartfailure.123.010841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/20/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Metabolic dysfunction-associated fatty liver disease (MAFLD) is a risk factor for heart failure (HF) occurrence, but it remains unclear whether the association between MAFLD and HF differs in different sexes and ages. METHODS A total of 96 576 participants of Kailuan Study were included. MAFLD was defined as presence of hepatic steatosis and metabolic dysfunction and classified as mild and significant by ultrasound. Hazard ratios (HRs) were calculated by Cox regression models. RESULTS After a median follow-up of 14.0 years, 2939 participants developed HF. Adjusting for confounding factors, mild-MAFLD (HR, 1.27 [95% CI, 1.16-1.39]) and significant-MAFLD (HR, 1.45 [95% CI, 1.31-1.63]) were associated with a higher risk of HF in all participants, and the risk differed by sex (Pinteraction<0.05) and age (Pinteraction<0.001). Compared with non-MAFLD participants, in women, significant-MAFLD was associated with an 84% (HR, 1.84 [95% CI, 1.43-2.37]) increased risk of HF; however, in men, the risk was 36% (HR, 1.36 [95% CI, 1.20-1.53]). In participants under 45 years, mild-MAFLD and significant-MAFLD had a 55% (HR, 1.55 [95% CI, 1.07-2.25]) and 172% (HR, 2.72 [95% CI, 1.87-3.97]) increased risk of HF; however, in participants over 65 years, even significant-MAFLD did not associate with a higher risk of HF (HR, 1.11 [95% CI, 0.92-1.34]). Afterwards, we stratified all participants by both sex and age and found that the risk of MAFLD-associated HF decreased with age in men (Pinteraction<0.05) and women (Pinteraction<0.05), but the sex difference in this risk was only present in participants younger than 45 years (Pinteraction<0.05). CONCLUSIONS MAFLD greatly increased the risk of HF in women, especially young women. With increasing age, MAFLD-related risk of HF decreased and the difference between men and women disappeared.
Collapse
Affiliation(s)
- Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China (S.W., S.C.)
| | - Yuhao Li
- Department of Epidemiology and Biostatistics, School of Public Health, (Y.L., Y.Z., X.S., G.X., Y.H.), Capital Medical University, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.L., Y.Z., X.S., G.X.)
| | - Yijun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, (Y.L., Y.Z., X.S., G.X., Y.H.), Capital Medical University, China
| | - Xin Su
- Department of Epidemiology and Biostatistics, School of Public Health, (Y.L., Y.Z., X.S., G.X., Y.H.), Capital Medical University, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.L., Y.Z., X.S., G.X.)
| | - Yingting Zuo
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital (Y.Z.), Capital Medical University, China
| | - Guojuan Chen
- Department of Neurology, Beijing Tiantan Hospital (G.C., A.W.), Capital Medical University, China
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (G.C.), Capital Medical University, China
| | - Guozheng Xu
- Department of Epidemiology and Biostatistics, School of Public Health, (Y.L., Y.Z., X.S., G.X., Y.H.), Capital Medical University, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.L., Y.Z., X.S., G.X.)
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China (S.W., S.C.)
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, (Y.L., Y.Z., X.S., G.X., Y.H.), Capital Medical University, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital (G.C., A.W.), Capital Medical University, China
| |
Collapse
|
15
|
Wen W, Li Q, She J, Bai X, Zhang L, Li R, Wu Y, Zhou J, Yuan Z. Predictive value of serum TBA for 2-year MACEs in ACS patients undergoing PCI: a prospective cohort study. Sci Rep 2024; 14:1733. [PMID: 38242883 PMCID: PMC10799034 DOI: 10.1038/s41598-023-50304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
Bile acids play important roles in lipid metabolism and glucose homeostasis. Limited research exist on the association between serum total bile acid (TBA) levels and major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS), particularly those with comorbid type 2 diabetes mellitus (T2DM). This study was conducted to examine the relationship between baseline serum TBA level and T2DM status in patients with ACS after percutaneous coronary intervention (PCI) and to identify the predictive value of TBA levels for a 2-year risk of MACEs. 425 ACS patients underwent PCI were recruited and divided into three groups based on baseline serum TBA concentration. An analysis of the association between the T2DM status and baseline serum TBA levels was conducted using univariate linear regression and multivariate linear regression. The predictive relevance of serum TBA levels was evaluated using the receiver operating characteristic (ROC) curve and Cox regression. Kaplan-Meier curves were employed to analyze the differences among groups in predicting MACEs over a 2-year follow-up period. Baseline serum TBA levels were higher in ACS patients who were diagnosed with T2DM (the median 3.6 µmol/L) than those without T2DM (the median 3.0 µmol/L). T2DM status in ACS patients was positively correlated with baseline serum TBA concentrations (β: 1.7, 95% confidence interval [CI] 0.3-3.0), particularly in the male (β: 2.0, 95% CI 0.3-3.6) and 50-69-year-old (β: 2.5, 95% CI 0.6-4.4) populations. The areas under the ROC curve of baseline serum TBA levels predicted MACEs in ACS and ACS-T2DM patients following PCI were 0.649 (95% CI 0.595-0.703) and 0.783 (95% CI 0.685-0.881), respectively. Furthermore, Cox regression analysis showed that baseline serum TBA level was associated with the occurrence of MACEs in patients with ACS after PCI over a 2-year follow-up period, especially in those diagnosed with T2DM, whose baseline TBA concentration was lower than 10.0 µmol/L. ACS Patients with T2DM had higher serum TBA levels. TBA level at baseline was an independent predictor of MACEs in ACS patients who underwent PCI, especially with comorbid T2DM.
Collapse
Affiliation(s)
- Wen Wen
- Department of Ultrasound, Clinical Medical College, First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
| | - Qinze Li
- Department of Ultrasound, Clinical Medical College, First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jianqing She
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiaofang Bai
- Department of Ultrasound, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Lisha Zhang
- Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruifeng Li
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yan Wu
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Juan Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Molecular Cardiology, Xi'an, Shaanxi Province, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
- Key Laboratory of Molecular Cardiology, Xi'an, Shaanxi Province, China.
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China.
| |
Collapse
|
16
|
Yen FS, Hou MC, Wei JCC, Shih YH, Hwu CM, Hsu CC. Effects of glucagon-like peptide-1 receptor agonists on liver-related and cardiovascular mortality in patients with type 2 diabetes. BMC Med 2024; 22:8. [PMID: 38172833 PMCID: PMC10765623 DOI: 10.1186/s12916-023-03228-4] [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: 03/24/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Patients with type 2 diabetes (T2D) tend to have nonalcoholic fatty liver disease (NAFLD) with poorer prognosis. We performed this research to compare the risks of cardiovascular diseases, cirrhosis, liver-related mortality, and cardiovascular mortality between glucagon-like peptide-1 receptor agonist (GLP-1 RA) use and no-use in patients with T2D without viral hepatitis. METHODS From January 1, 2008, to December 31, 2018, we used propensity-score matching to identify 31,183 pairs of GLP-1 RA users and nonusers from Taiwan's National Health Insurance Research Database. Multivariable-adjusted Cox proportional hazards models were used to examine the outcomes between the study and control groups. RESULTS The median (Q1, Q3) follow-up time for GLP-1 RA users and nonusers were 2.19 (1.35, 3.52) and 2.14 (1.19, 3.68) years, respectively. The all-cause mortality incidence rate was 5.67 and 13.06 per 1000 person-years for GLP-1 RA users and nonusers, respectively. Multivariable-adjusted analysis showed that GLP-1 RA use had significantly lower risks of all-cause mortality (aHR 0.48, 95%CI 0.43-0.53), cardiovascular events (aHR 0.92, 95%CI 0.86-0.99), cardiovascular death (aHR 0.57, 95%CI 0.45-0.72), and liver-related death (aHR 0.32, 95%CI 0.13-0.75). However, there was no significant difference in the risk of liver cirrhosis development, hepatic failure, and hepatocellular carcinoma compared to GLP-1 RA no-use. CONCLUSIONS This nationwide cohort study showed that GLP-1 RA use was associated with a significantly lower risk of all-cause mortality, cardiovascular events, and cardiovascular death in patients with T2D among Taiwan population. More prospective studies are warranted to verify our results.
Collapse
Affiliation(s)
- Fu-Shun Yen
- Dr. Yen's Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Ying-Hsiu Shih
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| | - Chii-Min Hwu
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan.
| |
Collapse
|
17
|
Bellini MI, Gissey LC, Nemeth DV, D'Andrea V, Illuminati G, Marchitelli S, Lai S, Casella G. Sleeve gastrectomy and one-year outcomes: Impact on cardiovascular, renal and metabolic parameters. Surg Open Sci 2024; 17:65-69. [PMID: 38298437 PMCID: PMC10828425 DOI: 10.1016/j.sopen.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/21/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Background Cardiovascular and renal diseases represent a major determinant for the morbidity and mortality associated with obesity and type 2 diabetes mellitus (T2DM). Bariatric surgery is considered one of the few treatments with the potential to reverse cardiovascular, renal and metabolic disease. Methods Prospective study of patients undergoing sleeve gastrectomy collecting pre- and post-surgery creatinine, eGFR, glucose, insulin, total, LDL/HDL cholesterol, triglycerides, parathyroid hormone, vitamin D3, C- Reactive Protein (CRP), blood count, weight, body mass index (BMI), bilateral carotid intima media thickness (IMT), flow-mediated dilation (FMD) and epicardial adipose tissue (EAT). Measurements were compared at 1 year follow up. Results 24 patients were included in the study. Cardiovascular parameters, as HDL-cholesterol (p = 0.002), IMT (p = 0.003), EAT (p < 0.001) and FMD (p = 0.001) showed significant improvement after surgery. Secondary renal outcomes including Vitamin D3 (p < 0.0001), Calcium (p = 0.006), RBCs (p = 0.007), HCO3- (p = 0.05) also ameliorated as well as BMI (p < 0.001). Conclusions Sleeve gastrectomy has a positive impact on cardiovascular, renal, and metabolic parameters in patients with morbid obesity, suggesting it may halt the progression of these diseases even in the preclinical stage. Further research is needed to explore the long-term effects underlying these improvements.
Collapse
Affiliation(s)
| | | | - Denise V. Nemeth
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX 78235, USA
| | - Vito D'Andrea
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
| | - Giulio Illuminati
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
| | - Serena Marchitelli
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Silvia Lai
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanni Casella
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
| |
Collapse
|
18
|
Zhou Y, Suo W, Zhang X, Liang J, Zhao W, Wang Y, Li H, Ni Q. Targeting mitochondrial quality control for diabetic cardiomyopathy: Therapeutic potential of hypoglycemic drugs. Biomed Pharmacother 2023; 168:115669. [PMID: 37820568 DOI: 10.1016/j.biopha.2023.115669] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023] Open
Abstract
Diabetic cardiomyopathy is a chronic cardiovascular complication caused by diabetes that is characterized by changes in myocardial structure and function, ultimately leading to heart failure and even death. Mitochondria serve as the provider of energy to cardiomyocytes, and mitochondrial dysfunction plays a central role in the development of diabetic cardiomyopathy. In response to a series of pathological changes caused by mitochondrial dysfunction, the mitochondrial quality control system is activated. The mitochondrial quality control system (including mitochondrial biogenesis, fusion and fission, and mitophagy) is core to maintaining the normal structure of mitochondria and performing their normal physiological functions. However, mitochondrial quality control is abnormal in diabetic cardiomyopathy, resulting in insufficient mitochondrial fusion and excessive fission within the cardiomyocyte, and fragmented mitochondria are not phagocytosed in a timely manner, accumulating within the cardiomyocyte resulting in cardiomyocyte injury. Currently, there is no specific therapy or prevention for diabetic cardiomyopathy, and glycemic control remains the mainstay. In this review, we first elucidate the pathogenesis of diabetic cardiomyopathy and explore the link between pathological mitochondrial quality control and the development of diabetic cardiomyopathy. Then, we summarize how clinically used hypoglycemic agents (including sodium-glucose cotransport protein 2 inhibitions, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, thiazolidinediones, metformin, and α-glucosidase inhibitors) exert cardioprotective effects to treat and prevent diabetic cardiomyopathy by targeting the mitochondrial quality control system. In addition, the mechanisms of complementary alternative therapies, such as active ingredients of traditional Chinese medicine, exercise, and lifestyle, targeting mitochondrial quality control for the treatment of diabetic cardiomyopathy are also added, which lays the foundation for the excavation of new diabetic cardioprotective drugs.
Collapse
Affiliation(s)
- Yutong Zhou
- Guang'an Men Hospital, China Academy of Chinese Medicine, Beijing 100053, China
| | - Wendong Suo
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Xinai Zhang
- Guang'an Men Hospital, China Academy of Chinese Medicine, Beijing 100053, China
| | - Jiaojiao Liang
- Zhengzhou Shuqing Medical College, Zhengzhou 450064, China
| | - Weizhe Zhao
- College of Traditional Chinese Medicine, Beijing University of Traditional Chinese Medicine, Beijing 100105, China
| | - Yue Wang
- Capital Medical University, Beijing 100069, China
| | - Hong Li
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Qing Ni
- Guang'an Men Hospital, China Academy of Chinese Medicine, Beijing 100053, China.
| |
Collapse
|
19
|
Wang L, Wang S, Song C, Yu Y, Jiang Y, Wang Y, Li X. Bibliometric analysis of residual cardiovascular risk: trends and frontiers. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:132. [PMID: 38017531 PMCID: PMC10683255 DOI: 10.1186/s41043-023-00478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The presence of residual cardiovascular risk is an important cause of cardiovascular events. Despite the significant advances in our understanding of residual cardiovascular risk, a comprehensive analysis through bibliometrics has not been performed to date. Our objective is to conduct bibliometric studies to analyze and visualize the current research hotspots and trends related to residual cardiovascular risk. This will aid in understanding the future directions of both basic and clinical research in this area. METHODS The literature was obtained from the Web of Science Core Collection database. The literature search date was September 28, 2022. Bibliometric indicators were analyzed using CiteSpace, VOSviewer, Bibliometrix (an R package), and Microsoft Excel. RESULT A total of 1167 papers were included, and the number of publications is increasing rapidly in recent years. The United States and Harvard Medical School are the leading country and institution, respectively, in the study of residual cardiovascular risk. Ridker PM and Boden WE are outstanding investigators in this field. According to our research results, the New England Journal of Medicine is the most influential journal in the field of residual cardiovascular risk, whereas Atherosclerosis boasts the highest number of publications on this topic. Analysis of keywords and landmark literature identified current research hotspots including complications of residual cardiovascular risk, risk factors, and pharmacological prevention strategies. CONCLUSION In recent times, global attention toward residual cardiovascular risk has significantly increased. Current research is focused on comprehensive lipid-lowering, residual inflammation risk, and dual-pathway inhibition strategies. Future efforts should emphasize strengthening international communication and cooperation to promote the comprehensive evaluation and management of residual cardiovascular risk.
Collapse
Affiliation(s)
- Lin Wang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Sutong Wang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chaoyuan Song
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Neurology, Zibo Central Hospital, Zibo, China
| | - Yiding Yu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuehua Jiang
- Central Laboratory, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongcheng Wang
- Department of Cardiovascular, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiao Li
- Department of Cardiovascular, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
| |
Collapse
|
20
|
Celik A, Esin FK, Emren SV, Kiris T, Karaca M. The Clinical Value of the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy Score in Predicting Long-Term Major Adverse Cardiovascular And Cerebrovascular Events and Major Bleeding in Acute Coronary Syndrome Patients Who Underwent Percutaneous Coronary Intervention. Angiology 2023; 74:958-969. [PMID: 36113050 DOI: 10.1177/00033197221127073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The PRECISE-DAPT (predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy) score is recommended for predicting out-of-hospital bleeding after percutaneous coronary intervention (PCI). However, its long-term prediction remains unclear. We investigated the performance of this score in predicting long-term outcomes in patients with the acute coronary syndrome (ACS). We divided retrospectively enrolled patients (n = 1071) into two groups according to their PRECISE-DAPT scores: low < 25 and high ≥ 25. Bleeding was assessed using the Bleeding Academic Research Consortium criteria. The ischemic endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). During follow-up (median 7.3 years), MACCE (55 vs 35%, P<.001) and major bleeding (9 vs 4%, P = .002) rates were greater in the high score group. The PRECISE-DAPT score was an independent predictor of MACCE in multivariate analysis (Hazard ratio [HR]: 1.028, 95% confidence interval [CI]: 1.016-1.039, P < .001). Also, the PRECISE-DAPT score predicted all-cause mortality (HR: 2.115, 95% CI: 1.508-2.965, P < .001) at long-term follow-up. The PRECISE-DAPT score may be useful for predicting MACCE at long-term follow-up in addition to the risk of bleeding.
Collapse
Affiliation(s)
- Aykan Celik
- Department of Cardiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Fatma Kayaltı Esin
- Department of Cardiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Sadık Volkan Emren
- Department of Cardiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Tuncay Kiris
- Department of Cardiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Mustafa Karaca
- Department of Cardiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| |
Collapse
|
21
|
Özcan A, Nijland N, Gerdes VEA, Bruers JJM, Loos BG. Willingness for Medical Screening in a Dental Setting-A Pilot Questionnaire Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6969. [PMID: 37947527 PMCID: PMC10650185 DOI: 10.3390/ijerph20216969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
An important way to manage noncommunicable diseases (NCDs) is to focus on prevention, early detection, and reducing associated risk factors. Risk factors can be detected with simple general health checks, which can also be performed in dental clinics. The purpose of this study was to investigate participants' willingness to participate in general health checks at the dentist, in particular the difference in opinion between medical patients and random healthy dental attendees. A total of 100 medical patients from an outpatient internal medicine clinic and 100 dental clinic attendees were included (total of 200 participants). The participants were asked for their opinion using six closed-ended questions. Overall, 91.0% of participants were receptive to information about the risk of diabetes mellitus (DM) and cardiovascular diseases (CVD). The majority (80-90%) was receptive to screening for DM and CVD risk, such as weight and height measurements, blood pressure measurement, saliva testing for CVD and to measure glucose and cholesterol via finger stick. No significant differences were found in the frequencies of the responses between the different groups based on health status, age, sex, or cultural background. This study shows that most participants are willing to undergo medical screening at the dentist for early detection and/or prevention of common NCDs.
Collapse
Affiliation(s)
- Asiye Özcan
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands (B.G.L.)
| | - Nina Nijland
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands (B.G.L.)
| | - Victor E. A. Gerdes
- Department of Internal Medicine, Amsterdam University Medical Center (AUMC), University of Amsterdam and Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Internal Medicine, Spaarne Gasthuis, 2134 TM Hoofddorp, The Netherlands
| | - Josef J. M. Bruers
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
- Royal Dutch Dental Association (KNMT), 3528 BB Utrecht, The Netherlands
| | - Bruno G. Loos
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands (B.G.L.)
| |
Collapse
|
22
|
Srinivasan S, Wu P, Mercader JM, Udler MS, Porneala BC, Bartz TM, Floyd JS, Sitlani C, Guo X, Haessler J, Kooperberg C, Liu J, Ahmad S, van Duijn C, Liu CT, Goodarzi MO, Florez JC, Meigs JB, Rotter JI, Rich SS, Dupuis J, Leong A. A Type 1 Diabetes Polygenic Score Is Not Associated With Prevalent Type 2 Diabetes in Large Population Studies. J Endocr Soc 2023; 7:bvad123. [PMID: 37841955 PMCID: PMC10576255 DOI: 10.1210/jendso/bvad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 10/17/2023] Open
Abstract
Context Both type 1 diabetes (T1D) and type 2 diabetes (T2D) have significant genetic contributions to risk and understanding their overlap can offer clinical insight. Objective We examined whether a T1D polygenic score (PS) was associated with a diagnosis of T2D in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium. Methods We constructed a T1D PS using 79 known single nucleotide polymorphisms associated with T1D risk. We analyzed 13 792 T2D cases and 14 169 controls from CHARGE cohorts to determine the association between the T1D PS and T2D prevalence. We validated findings in an independent sample of 2256 T2D cases and 27 052 controls from the Mass General Brigham Biobank (MGB Biobank). As secondary analyses in 5228 T2D cases from CHARGE, we used multivariable regression models to assess the association of the T1D PS with clinical outcomes associated with T1D. Results The T1D PS was not associated with T2D both in CHARGE (P = .15) and in the MGB Biobank (P = .87). The partitioned human leukocyte antigens only PS was associated with T2D in CHARGE (OR 1.02 per 1 SD increase in PS, 95% CI 1.01-1.03, P = .006) but not in the MGB Biobank. The T1D PS was weakly associated with insulin use (OR 1.007, 95% CI 1.001-1.012, P = .03) in CHARGE T2D cases but not with other outcomes. Conclusion In large biobank samples, a common variant PS for T1D was not consistently associated with prevalent T2D. However, possible heterogeneity in T2D cannot be ruled out and future studies are needed do subphenotyping.
Collapse
Affiliation(s)
- Shylaja Srinivasan
- Division of Pediatric Endocrinology, University of California at San Francisco, San Francisco, CA 94158, USA
| | - Peitao Wu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02215, USA
| | - Josep M Mercader
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA 02142, USA
- Center for Genomic Medicine and Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Miriam S Udler
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA 02142, USA
- Center for Genomic Medicine and Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bianca C Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA 98195, USA
| | - James S Floyd
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA 98195, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Colleen Sitlani
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA 98195, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Xiquing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Jeffrey Haessler
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Jun Liu
- Department of Epidemiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
- Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Shahzad Ahmad
- Department of Epidemiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Cornelia van Duijn
- Department of Epidemiology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
- Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Ching-Ti Liu
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Mark O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jose C Florez
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA 02142, USA
- Center for Genomic Medicine and Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James B Meigs
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of Harvard & Massachusetts Institute of Technology, Cambridge, MA 02142, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Stephen S Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02215, USA
| | - Aaron Leong
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Center for Genomic Medicine and Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
23
|
Tudoran C, Tudoran M, Giurgi-Oncu C, Abu-Awwad A, Abu-Awwad SA, Voiţă-Mekereş F. Associations between Oral Glucose-Lowering Agents and Increased Risk for Life-Threatening Arrhythmias in Patients with Type 2 Diabetes Mellitus-A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1760. [PMID: 37893478 PMCID: PMC10608201 DOI: 10.3390/medicina59101760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/02/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The relationship between type 2 diabetes mellitus (T2DM) and cardiovascular (CV) morbidity and mortality is well-established. Ventricular arrhythmias (VA) are frequently diagnosed in patients with T2DM, especially in those with associated coronary syndrome, non-ischemic dilated cardiomyopathy (NIDCM), and heart failure (HF). In these patients, VA and sudden cardiac arrest (SCA) are considered responsible for more than 50% of CV deaths. Newly developed glucose-lowering agents (GLA) seem not only to ameliorate CV morbidity and mortality, but also to reduce the risk of VA and SCA. Materials and Methods: We researched the medical literature on Pub-Med, Clarivate, and Google Scholar for original articles published in the last five years that debated the possible effects of various GLA on ventricular arrhythmias. Results: We identified nineteen original articles, nine of them debating the antiarrhythmic effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i); Conclusions: The results concerning the impact of various GLA on VA/SCA were heterogeneous depending on the pharmacological class studied, with some of them having neutral, positive, or negative effects. Although it appears that SGLT2i reduces the prevalence of atrial fibrillation and SCA, their effect on VA is not conclusive.
Collapse
Affiliation(s)
- Cristina Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of the University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital “Pius Brinzeu”, L. Rebreanu, Nr. 156, 300723 Timisoara, Romania; (C.G.-O.); (A.A.-A.); (S.-A.A.-A.)
| | - Mariana Tudoran
- County Emergency Hospital “Pius Brinzeu”, L. Rebreanu, Nr. 156, 300723 Timisoara, Romania; (C.G.-O.); (A.A.-A.); (S.-A.A.-A.)
| | - Catalina Giurgi-Oncu
- County Emergency Hospital “Pius Brinzeu”, L. Rebreanu, Nr. 156, 300723 Timisoara, Romania; (C.G.-O.); (A.A.-A.); (S.-A.A.-A.)
- Discipline of Psychiatry, Department of Neuroscience, University of Medicine and Pharmacy “Victor Babes” Timisoara, Eftimie Murgu Place Nr. 2, 300041 Timisoara, Romania
| | - Ahmed Abu-Awwad
- County Emergency Hospital “Pius Brinzeu”, L. Rebreanu, Nr. 156, 300723 Timisoara, Romania; (C.G.-O.); (A.A.-A.); (S.-A.A.-A.)
- Department XV, Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Center University Professor Doctor Teodor Șora, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Simona-Alina Abu-Awwad
- County Emergency Hospital “Pius Brinzeu”, L. Rebreanu, Nr. 156, 300723 Timisoara, Romania; (C.G.-O.); (A.A.-A.); (S.-A.A.-A.)
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Florica Voiţă-Mekereş
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 Universitatii Street, 410087 Oradea, Romania;
| |
Collapse
|
24
|
Dagli N, Kumar S, Ahmad R, Narwaria M, Haque M. An Update on Semaglutide Research: A Bibliometric Analysis and a Literature Review. Cureus 2023; 15:e46510. [PMID: 37808605 PMCID: PMC10552354 DOI: 10.7759/cureus.46510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/10/2023] Open
Abstract
This study analyzes the most relevant authors, sources, cooccurrence of keywords, thematic map, and trend topics of the most recent and most cited research papers on semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA). Also, the content of the 25 most cited papers is summarized. A total of 2995 results appeared in an online electronic search performed on 14 August 2023 in the Scopus database using the term semaglutide. The most recently published 500 articles and most cited 200 documents were selected for bibliometric analysis. Network analysis visualization was conducted with the help of the VOSviewer software (version 1.6.18) (Centre for Science and Technology Studies, Leiden, the Netherlands) and Biblioshiny (it is a shiny application providing a web interface for bibliometrix) (Department of Economics and Statistics, University of Naples Federico II, Naples, Italy). After excluding duplicates and editorials, the data analysis found that 495 most recent documents were published in 279 journals by 2461 authors, and 200 most cited papers were published in 103 sources by 1241 authors. There is an increasing trend in the number of research papers from 2014 to 2022, with a peak in 2022. The most relevant authors in the most recent semaglutide research papers are Chen and Zhang. The pertinent authors of the most cited research papers on semaglutide are Lingvay and Khunti. The most common keywords used in the most recent and most cited research papers are semaglutide, obesity, diabetes mellitus type 2, glucagon-like peptide-1, glucagon-like peptide-1 receptor agonist, antidiabetic agent, liraglutide, and cardiovascular disease (CVD). The most relevant source is "Diabetes, Obesity and Metabolism" for the research papers on semaglutide. Trend topic analysis suggests that most of the research between 2020 and 2022 on semaglutide was done on non-insulin-dependent diabetes mellitus. The most cited papers provide essential insights into using semaglutide in managing type 2 diabetes mellitus (T2DM), obesity, and related conditions, along with their potential benefits, side effects, and possible mechanisms of action. This analysis highlights that the pharmacological effects of semaglutide extend beyond its role as a glycemic regulator.
Collapse
Affiliation(s)
- Namrata Dagli
- Dentistry, Karnavati Scientific Research Center, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Santosh Kumar
- Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Rahnuma Ahmad
- Physiology, Medical College for Women and Hospital, Dhaka, BGD
| | | | - Mainul Haque
- Dentistry, Karnavati Scientific Research Center, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| |
Collapse
|
25
|
Davis TME, Colman PG, Hespe C, Heywood SE, d'Emden M. Cardiovascular disease management in Australian adults with type 2 diabetes: insights from the CAPTURE study. Intern Med J 2023; 53:1796-1805. [PMID: 36112472 DOI: 10.1111/imj.15929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/30/2022] [Indexed: 10/21/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is a well-recognised cardiovascular disease (CVD) risk factor, and recent guidelines for the management of T2D include consideration of CVD risk. AIM To assess whether contemporary clinical management of Australians with T2D is in accord with recent national and international guidelines. METHODS This Australia-specific analysis of the CAPTURE study, a non-interventional, cross-sectional study included adults diagnosed with T2D ≥180 days prior to providing informed consent and visiting primary or specialist care. Main outcome measures were the use of blood glucose-lowering medications (BGLMs), BGLMs with proven cardiovascular benefits and other CVD medications, stratified by CVD status and care setting. RESULTS Of 824 Australian participants in the CAPTURE sample, 332 (40.3%) had CVD. Oral BGLMs were used by 83.9% of all participants, most commonly metformin (76.0%), dipeptidyl peptidase-4 inhibitors (28.8%), sodium-glucose cotransporter-2 inhibitors (SGLT2is; 21.8%) and sulfonylureas (21.7%). Insulin was used by 29.2% of participants. BGLMs with proven CV benefit were used by 22.6%; glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were less commonly used than SGLT2is in all CVD groups, but these drug classes were more often prescribed in specialist than primary care (SGLT2is 25.4 vs 20.7%, GLP-1 RAs 3.2 vs 0.8% respectively). Use of non-BGLMs for CVD risk reduction appeared consistent with guidelines. CONCLUSIONS Use of BGLMs with CVD benefits appears low in Australia, irrespective of CVD status. This likely reflects the delay in translation of clinical evidence into contemporary care and prescribing restrictions.
Collapse
Affiliation(s)
- Timothy M E Davis
- Medical School, University of Western Australia, and Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Peter G Colman
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Charlotte Hespe
- General Practice and Primary Care Research, School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | | | - Michael d'Emden
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
26
|
Tanveer Y, Sanipini S, Khleif R, Tsenteradze T, Gapizov A, Grezenko H, Affaf M, Abdelaziz AM, Rehman A, Zia U, Jama H, Shehryar A, Mohsin SN, Ekhator C, Khan R. Transforming Medical Paradigms: A Cutting-Edge Review of Genomic and Robotic Medical and Surgical Approaches in the Battle Against Diabetes, Hypertension, and Cardiovascular Issues. Cureus 2023; 15:e46998. [PMID: 37965396 PMCID: PMC10641027 DOI: 10.7759/cureus.46998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
This article provides an in-depth review of the current state of management for diabetes, hypertension, and cardiovascular disease, focusing on advancements from genomics to robotics. It explores the role of genomic markers in personalized medicine, offering tailored treatment options for these chronic conditions. The article also examines the efficacy of various pharmacological and surgical interventions, including bariatric surgery for diabetes and device-based treatments for hypertension. A comparative analysis is presented to evaluate the cost-effectiveness and patient outcomes between medical and surgical approaches. The review concludes that while personalized medicine and minimally invasive surgical techniques show promise, more high-quality comparative research is needed. The ultimate goal is to integrate these emerging technologies within a framework of evidence-based medicine to improve patient outcomes and health equity.
Collapse
Affiliation(s)
| | | | - Rafeef Khleif
- Medical School, Xavier University School of Medicine, Oranjestad, ABW
| | - Tamar Tsenteradze
- General Surgery, Tbilisi State Medical Univerity, Tbilisi, GEO
- Cardiology, Tbilisi State Medical Univerity, Tbilisi, GEO
- Internal Medicine, Tbilisi State Medical Univerity, Tbilisi, GEO
| | - Abubakar Gapizov
- General Surgery, American University of Antigua, Saint George, ATG
| | - Han Grezenko
- Translational Neuroscience, Barrow Neurological Institute, Phoenix, USA
| | - Maryam Affaf
- Internal Medicine, Women's Medical and Dental College, Abbotabad, PAK
| | - Ali M Abdelaziz
- Internal Medicine, Alexandria University Faculty of Medicine, Alexandria, EGY
| | | | - Umar Zia
- Internal Medicine, Khyber Medical University, Peshawar, PAK
| | - Huda Jama
- Internal Medicine, Nishtar Medical University, Multan, PAK
| | | | | | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
| | - Rehman Khan
- Internal Medicine, Mayo Hospital, Lahore, PAK
| |
Collapse
|
27
|
Onishi Y, Shirabe S, Eguchi K, Nishijima K, Sato T, Seino H. Use of diabetes medications in adults with T2D and CVD in Japan: secondary analysis of the CAPTURE study. Diabetol Int 2023; 14:363-371. [PMID: 37781463 PMCID: PMC10533472 DOI: 10.1007/s13340-023-00638-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/09/2023] [Indexed: 10/03/2023]
Abstract
Introduction The CAPTURE study estimated the global prevalence of established cardiovascular disease (CVD) and characterized the usage of glucose-lowering agents (GLAs) in adults with type 2 diabetes (T2D) across 13 countries. The purpose of this secondary analysis of data from the Japanese sites within CAPTURE (NCT03786406, NCT03811288) was to provide data about medication usage stratified by CVD status among Japanese participants with T2D. Materials and methods Data on GLA usage (including those with proven cardiovascular [CV] benefits) in Japanese participants with T2D managed in clinics or hospitals were collected and stratified by CVD subgroups. Results There were 800 Japanese participants in the CAPTURE study (n = 502 [no CVD group], n = 298 [CVD group], n = 268 [atherosclerotic CVD subgroup]). Oral antidiabetic agents and insulin were used by 88.5% and 23.4%, respectively, of participants overall. Among participants with established CVD, dipeptidyl peptidase-4 inhibitors (65.1%) were most frequently used, followed by biguanides (50.7%) and insulins (26.2%). The pattern was similar among participants with atherosclerotic CVD. A lower proportion of participants in the CVD group used glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) with proven CV benefits versus the no CVD group (GLP-1 RAs: 7.0% vs. 8.6%; SGLT-2is: 13.4% vs. 19.1%). Conclusion This analysis of the CAPTURE study provided a comprehensive overview of prescription patterns for the treatment of T2D in Japan. Use of GLAs with proven CV benefit was low, even in participants with established CVD, which was comparable to the findings from the global cohort. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-023-00638-w.
Collapse
Affiliation(s)
- Yukiko Onishi
- The Institute of Medical Science, Asahi Life Foundation, 2-2-6 Nihonbashibakurocho, Chuo-ku, Tokyo, 103-0002 Japan
| | | | | | | | | | | |
Collapse
|
28
|
Lee BW, Ahn KJ, Cho HC, Lee EY, Min K, Dahaoui A, Jeong JS, Lim HJ, Jang HC. Safety and Clinical Outcomes of Insulin Degludec in Korean Patients with Diabetes in Real-World Practices: A Prospective, Observational Study. Diabetes Ther 2023; 14:1659-1672. [PMID: 37468685 PMCID: PMC10499774 DOI: 10.1007/s13300-023-01448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION To investigate the safety and effectiveness of insulin degludec (IDeg) in a real-world population of Korean patients with diabetes requiring insulin therapy. METHODS This was a multicenter, prospective, single-arm, open-label, non-interventional study. Patients aged ≥ 12 months and treated with previous glucose-lowering medications were eligible to switch to IDeg. The primary endpoint was the incidence of adverse events (AEs), and the secondary endpoints were changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial glucose (PPG), and target HbA1c < 7.0%. RESULTS In total, 3225 and 2450 patients were included in the safety analysis set (SAS) and effectiveness analysis set (EAS), respectively. The mean baseline HbA1c and duration of diabetes were 9.4% and 13.0 years, respectively. Adverse events were reported in 740 patients (22.9%); the majority were mild and resolved. Significant improvements were observed in HbA1c, FPG, and PPG at week 26 (all p < 0.0001). The target of HbA1c < 7% was achieved in 22.2% of patients at week 26. CONCLUSION In real-world clinical practice, 26 weeks of IDeg treatment resulted in significant reductions in glycemic parameters with a low incidence of AEs in Korean patients with diabetes. No new safety signals were observed. CLINICAL TRIALS REGISTRY AND REGISTRATION NUMBER This trial is registered under ClinicalTrials.gov (NCT02779413) and the universal trial number is [U1111-1176-2287].
Collapse
Affiliation(s)
- Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Jeung Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ho Chan Cho
- Department of Clinical Endocrinology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - 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, Seoul, Republic of Korea
| | - KyungWan Min
- Department of Endocrinology and Metabolism, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Amine Dahaoui
- Novo Nordisk Pharma Korea Limited, Seoul, Republic of Korea
| | - Jin Sook Jeong
- Novo Nordisk Pharma Korea Limited, Seoul, Republic of Korea
| | - Hyo Jin Lim
- Novo Nordisk Pharma Korea Limited, Seoul, Republic of Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
| |
Collapse
|
29
|
Zhang D, Gao H, Song X, Raposeiras-Roubín S, Abu-Assi E, Paulo Simao Henriques J, D'Ascenzo F, Saucedo J, Ramón González-Juanatey J, Wilton SB, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Huczek Z, Nie S, Fujii T, Correia L, Kawashiri MA, Southern D, Kalpak O. Optimal medical therapy improves outcomes in patients with diabetes mellitus and acute myocardial infarction. Diabetes Res Clin Pract 2023; 203:110833. [PMID: 37478977 DOI: 10.1016/j.diabres.2023.110833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
AIMS We aimed to explored the association between the use of optimal medical therapy (OMT) in patients with myocardial infarction (AMI) and diabetes mellitus (DM) and clinical outcomes. METHODS Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome (BleeMACS) is an international registry that enrolled participants with acute coronary syndrome followed up for at least 1 year across 15 centers from 2003 to 2014. Baseline characteristics and endpoints were analyzed. RESULTS Among 3095 (23.2%) patients with AMI and DM, 1898 (61.3%) received OMT at hospital discharge. OMT was associated with significantly reduced mortality (4.3% vs. 10.8%, p < 0.001), re-AMI (4.4% vs. 8.1%, p < 0.001), and composite endpoint of death/re-AMI (8.0% vs. 17.6%, p < 0.001). No difference was observed among regions. Propensity score matching confirmed that OMT significantly associated with lower mortality. After adjusting for confounding variables, OMT, drug-eluting stents, and complete revascularization were independent protective factors of 1-year mortality, whereas left ventricular ejection fraction and age were risk factors. CONCLUSIONS Guideline-recommended OMT was prescribed at suboptimal frequencies with geographic variations in this worldwide cohort. OMT can improve long-term clinical outcomes in patients with DM and AMI. CLINICAL TRIAL REGISTRATION NCT02466854 June 9, 2015.
Collapse
Affiliation(s)
- Dongfeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Hai Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China.
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China.
| | | | - Emad Abu-Assi
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Jorge Saucedo
- Department of Cardiology, North Shore University Hospital, Chicago, IL, USA
| | | | | | - Wouter J Kikkert
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Iván Nuñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Albert Ariza-Sole
- Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain
| | | | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Claudio Moretti
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Zenon Huczek
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Shaoping Nie
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, PR China
| | - Toshiharu Fujii
- Division of Cardiovascular Medicine, Department of Cardiology, Tokai University School of Medicine, Tokyo, Japan
| | - Luis Correia
- Department of Cardiology, Hospital São Rafael - Avenida São Rafael, Salvador, Brazil
| | - Masa-Aki Kawashiri
- Department of Cardiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | | | - Oliver Kalpak
- Interventional Cardiology, University Clinic of Cardiology, Skopje, Former Yugolav Republic of Macedonia, The
| |
Collapse
|
30
|
Langaas HC, Salvesen Ø, Dyrkorn R, Blix HS, Spigset O. Academic detailing as a method to improve general practitioners' drug prescribing in type 2 diabetes: evaluation of changes in prescribing. Scand J Prim Health Care 2023; 41:224-231. [PMID: 37326464 PMCID: PMC10478614 DOI: 10.1080/02813432.2023.2222781] [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: 09/14/2022] [Accepted: 06/04/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To investigate the effect of an academic detailing intervention on the utilisation of type 2 diabetes medication among general practitioners. DESIGN We developed an academic detailing campaign based on the revised national treatment guideline for diabetes and the best available evidence. General practitioners were offered a 20-minute one-to-one visit by a trained academic detailer. SETTING AND SUBJECTS A total of 371 general practitioners received a visit and represented the intervention group. The control group consisted of 1282 general practitioners not receiving a visit. MAIN OUTCOME MEASURES Changes in prescribing from 12 months before to 12 months after the intervention. The primary endpoint was a change in metformin. Secondary endpoints were changes in other groups of Type 2 diabetes medication and of these drugs in total. RESULTS Prescribing of metformin increased by 7.4% in the intervention group and 5.2% in the control group (p = .043). Sodium-glucose cotransporter-2 inhibitors increased by 27.6% in the intervention group and 33.8% in the control group (p = .019). For sulfonylureas there was a decrease of 3.6% in the intervention group vs. 8.9% in the control group (p = .026). The total amount of prescribed medications for type 2 diabetes increased by 9.1% in the intervention group and 7.3% in the control group (p = .08). CONCLUSION Academic detailing initiated a small but statistically significant increase in the prescription of metformin. For a complex subject like type 2 diabetes, we recommend reserving more time in the visit than the 20 min our campaign aimed for.
Collapse
Affiliation(s)
- Harald Christian Langaas
- KUPP – The Norwegian Academic Detailing Program, Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Øyvind Salvesen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Roar Dyrkorn
- KUPP – The Norwegian Academic Detailing Program, Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
| | - Hege Salvesen Blix
- Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Olav Spigset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
| |
Collapse
|
31
|
Verdecchia P, Reboldi G, Angeli F. It Is Time to Reconsider the Blood Pressure Targets in Patients With Type 2 Diabetes? Hypertension 2023; 80:1654-1657. [PMID: 37470769 DOI: 10.1161/hypertensionaha.123.21461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, and Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia, Italy (P.V.)
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Italy (G.R.)
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.A.)
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy (F.A.)
| |
Collapse
|
32
|
Okada A, Yamana H, Pan R, Yamaguchi S, Kumazawa R, Matsui H, Fushimi K, Honda Y, Nangaku M, Yamauchi T, Yasunaga H, Kadowaki T, Kim Y. Effect modification of the association between temperature variability and hospitalization for cardiovascular disease by comorbid diabetes mellitus: A nationwide time-stratified case-crossover analysis. Diabetes Res Clin Pract 2023; 202:110771. [PMID: 37276982 DOI: 10.1016/j.diabres.2023.110771] [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: 03/01/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/07/2023]
Abstract
AIMS We aimed to explore the association between short-term exposure to temperature variability (TV), and cardiovascular hospitalization stratified by the presence of comorbid diabetes. METHODS We collected data on nationwide hospitalization for cardiovascular diseases and daily weather conditions during 2011-2018 in Japan. TV was calculated as the standard deviation of daily minimum and maximum temperatures within 0-7 lag days. We applied a two-stage time-stratified case-crossover design to estimate the association between TV and cardiovascular hospitalization with and without comorbid diabetes, adjusting for temperature and relative humidity. Furthermore, specific cardiovascular disease causes, demographic characteristics, and seasons were used for stratification. RESULTS In 3,844,910 hospitalizations for cardiovascular disease, each 1 °C increase in TV was associated with a 0.44% (95% CI: 0.22%, 0.65%) increase in the risk of cardiovascular admission. We observed a 2.07% (95% CI: 1.16%, 2.99%) and 0.61% (95% CI: -0.02%, 1.23%) increase per 1 °C in risk of heart failure admission in individuals with and those without diabetes, respectively. The higher risk among individuals with diabetes was mostly consistent in the analyses stratified by age, sex, body mass index, smoking status, and season. CONCLUSION Comorbid diabetes may increase susceptibility to TV in relation to acute cardiovascular disease hospitalization.
Collapse
Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Data Science Center, Jichi Medical University, Shimotsuke, Japan
| | - Rui Pan
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Toranomon Hospital, Tokyo, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| |
Collapse
|
33
|
Habas E, Akbar RA, Alfitori G, Farfar KL, Habas E, Errayes N, Habas A, Al Adab A, Rayani A, Geryo N, Elzouki ANY. Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect. Cureus 2023; 15:e42681. [PMID: 37649932 PMCID: PMC10464654 DOI: 10.7759/cureus.42681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep. It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression. A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.
Collapse
Affiliation(s)
| | - Raza A Akbar
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | | | | | - Eshrak Habas
- Internal Medicine, Tripoli University, Tripoli, LBY
| | - Nada Errayes
- Medical Education, University of Lincoln, Lincoln, GBR
| | - Aml Habas
- Renal and Dialysis, Tripoli Pediatric Hospital, Tripoli, LBY
| | - Aisha Al Adab
- Pulmonary Medicine, Hamad General Hospital, Doha, QAT
| | - Amnna Rayani
- Hemato-Oncology, Tripoli Pediatric Hospital, Tripoli University, Tripoli, LBY
| | - Nagat Geryo
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | - Abdel-Naser Y Elzouki
- Medicine, Hamad General Hospital, Doha, QAT
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| |
Collapse
|
34
|
Abstract
The number of older adults with type 1 diabetes (T1D) is increasing due to an overall increase in life expectancy and improvement in diabetes management and treatment of complications. They are a heterogeneous cohort due to the dynamic process of aging and the presence of comorbidities and diabetes-related complications. A high risk for hypoglycemia unawareness and severe hypoglycemia has been described. Periodic assessment of health status and adjustment of glycemic goals to mitigate hypoglycemia is imperative. Continuous glucose monitoring, insulin pump, and hybrid closed-loop systems are promising tools to improve glycemic control and mitigate hypoglycemia in this age group.
Collapse
Affiliation(s)
- Elena Toschi
- Joslin Diabetes Center; Beth Israel Deaconess Medical Center; Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
| |
Collapse
|
35
|
McCarthy MM, Yan J, Jared MC, Ilkowitz J, Gallagher MP, Dickson VV. Time, Technology, Social Support, and Cardiovascular Health of Emerging Adults With Type 1 Diabetes. Nurs Res 2023; 72:185-192. [PMID: 37084321 PMCID: PMC10123545 DOI: 10.1097/nnr.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
BACKGROUND Emerging adults with Type 1 diabetes (T1DM) face an increased risk of cardiovascular disease; however, there are both barriers and facilitators to achieving ideal cardiovascular health in this stage of their lives. OBJECTIVES The aim of this study was to qualitatively explore the barriers and facilitators of achieving ideal levels of cardiovascular health in a sample of emerging adults with T1DM ages 18-26 years. METHODS A sequential mixed-methods design was used to explore achievement of ideal cardiovascular health using the seven factors defined by the American Heart Association (smoking status, body mass index, physical activity, healthy diet, total cholesterol, blood pressure, and hemoglobin A1C [substituted for fasting blood glucose]). We assessed the frequency of achieving ideal levels of each cardiovascular health factor. Using Pender's health promotion model as a framework, qualitative interviews explored the barriers and facilitators of achieving ideal levels of each factor of cardiovascular health. RESULTS The sample was mostly female. Their age range was 18-26 years, with a diabetes duration between 1 and 20 years. The three factors that had the lowest achievement were a healthy diet, physical activity at recommended levels, and hemoglobin A1C of <7%. Participants described lack of time as a barrier to eating healthy, being physically active, and maintaining in-range blood glucose levels. Facilitators included the use of technology in helping to achieve in-range blood glucose and social support from family, friends, and healthcare providers in maintaining several healthy habits. DISCUSSION These qualitative data provide insight into how emerging adults attempt to manage their T1DM and cardiovascular health. Healthcare providers have an important role in supporting these patients in establishing ideal cardiovascular health at an early age.
Collapse
|
36
|
Jin J, Cui G, Mi N, Wu W, Zhang X, Xiao C, Wang J, Qiu X, Han M, Li Z, Wang L, Lu T, Niu H, Wu Z, Li J. Safety, pharmacokinetics, and pharmacodynamics of TG103, a novel long-acting GLP-1/Fc fusion protein after a single ascending dose in Chinese healthy subjects. Eur J Pharm Sci 2023; 185:106448. [PMID: 37062422 DOI: 10.1016/j.ejps.2023.106448] [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: 11/02/2022] [Revised: 02/20/2023] [Accepted: 04/10/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND AND OBJECTIVE TG103 is a novel GLP-1/Fc fusion protein, developed for the treatment of type 2 diabetes and obesity. This trial was designed to assess the safety and tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) profiles after single ascending dose of TG103 in healthy Chinese subjects. METHOD In this double-blind, randomized, placebo-controlled phase I study, Chinese healthy subjects were admitted consecutively to TG103 3 mg, 7.5 mg, 15 mg, and 22.5 mg group with 8 subjects per group and randomized in a 3:1 ratio to receive TG103 treatment or placebo. Following a single subcutaneous(s.c.) injections of TG103, safety and tolerability were evaluated and blood samples were collected for PK and PD analysis at the specified time-points. RESULT Overall, 32 healthy subjects were enrolled and completed the study. During the study, a total of 84 adverse effects (AEs) were reported in 25 subjects, all were mild or moderate and resolved spontaneously without intervention. The most common treatment related AEs in TG103 group were decreased appetite (41.7%), nausea, flatulence, elevated urinary β2-microglobulin, increased serum total bile acid (20.8% each), decreased high-density lipoprotein (16.7%), abdominal distension (12.5%). After a single s.c. administration of TG103 3-22.5 mg, the median Tmax was 36∼48 hours, and mean t1/2 was about 147.16∼184.72 hours. The mean Cmax for each group was 94.35±52.19, 337.67±56.71, 757.67±206.99, 1236.33±666.25 ng/mL, with AUC0-t of 14.93±7.67, 59.15±7.39, 91.79±20.41, 163.61±55.99 μg·h/mL, respectively. It showed a linear pharmacokinetic profile in the single dose of TG103 3 mg to 22.5 mg. Compared with placebo, fasting blood glucose decreased in all dose groups, most notably in the 15 mg group, which was consistent with the changes in blood glucose during OGTT, while 2-hour postprandial glucose decreased in all dose groups except 3 mg group. CONCLUSION TG103 offers a potential option for hypoglycemic therapy with good tolerability and safety. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT03990090; registered 18 June, 2019.
Collapse
Affiliation(s)
- Jiangli Jin
- Clinical Trial Research Center of China-Japan Friendship Hospital, Beijing, China; CSPC Zhongqi Pharmaceutical Technology (Shijiazhuang) Co., Ltd
| | - Gang Cui
- Clinical Trial Research Center of China-Japan Friendship Hospital, Beijing, China
| | - Na Mi
- Clinical Trial Research Center of China-Japan Friendship Hospital, Beijing, China
| | - Wei Wu
- Clinical Trial Research Center of China-Japan Friendship Hospital, Beijing, China
| | - Xin Zhang
- Clinical Trial Research Center of China-Japan Friendship Hospital, Beijing, China
| | - Chunyan Xiao
- Clinical Trial Research Center of China-Japan Friendship Hospital, Beijing, China
| | - Jing Wang
- Clinical Trial Research Center of China-Japan Friendship Hospital, Beijing, China; CSPC Zhongqi Pharmaceutical Technology (Shijiazhuang) Co., Ltd
| | | | - Mai Han
- Clinical Trial Research Center of China-Japan Friendship Hospital, Beijing, China
| | | | | | | | | | | | - Jintong Li
- Clinical Trial Research Center of China-Japan Friendship Hospital, Beijing, China.
| |
Collapse
|
37
|
Qiu W, Cai A, Xiao X, Gao Z, Feng Y, Li L. Diabetes mellitus status modifies the association between N-terminal B-type natriuretic peptide and all-cause mortality risk in ischemic heart failure: a prospective cohort study. Diabetol Metab Syndr 2023; 15:72. [PMID: 37041629 PMCID: PMC10088130 DOI: 10.1186/s13098-023-01046-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/29/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND N-terminal B-type natriuretic peptide (NT-proBNP) discriminates mortality risk in diabetes mellitus (DM) and in heart failure (HF) populations. Whether DM status modifies the association between NT-proBNP and all-cause mortality risk in ischemic HF is unknown. METHODS This was a single-center, prospective cohort study conducted with 2287 ischemic HF patients. Subjects were divided into with DM group and without DM group. Multivariate Cox proportional-hazards models were conducted to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). The product of DM status and NT-proBNP were used to assess the interaction. Propensity score matching analysis was used to verify the robustness of the results. RESULTS Of 2287 ischemic HF participants, 1172 (51.2%) had DM. After a median follow-up of 3.19 years (7287 person-years), 479 (20.9%) of the participants died. After adjusting for the covariates, continuous NT-proBNP was more prominently associated with risk of mortality in HF patients with DM (HR: 1.65, 95% CI: 1.43-1.91) than those without (HR: 1.28, 95% CI: 1.09-1.50). A significant interaction of DM status and NT-proBNP was observed (P-interaction = 0.016). The relationships were consistent when NT-proBNP was considered as a categorical variable and in the propensity matching analysis. CONCLUSIONS DM status modified the association between NT-proBNP and all-cause mortality in ischemic HF patients, suggesting that NT-proBNP was more prominently associated with risk of mortality in patients with DM than those without. Future studies to clarify the mechanisms underlying these observations are needed.
Collapse
Affiliation(s)
- Weida Qiu
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Anping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xiaoju Xiao
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhiping Gao
- Concord medical center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Guangdong Provincial People's Hospital, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Liwen Li
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Guangdong Provincial People's Hospital, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| |
Collapse
|
38
|
Chen D, Petersen ML, Rytgaard HC, Grøn R, Lange T, Rasmussen S, Pratley RE, Marso SP, Kvist K, Buse J, van der Laan MJ. Beyond the Cox Hazard Ratio: A Targeted Learning Approach to Survival Analysis in a Cardiovascular Outcome Trial Application. Stat Biopharm Res 2023. [DOI: 10.1080/19466315.2023.2173644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- David Chen
- Division of Biostatistics, UC Berkeley School of Public Health, Berkeley, CA
| | - Maya L. Petersen
- Division of Biostatistics, UC Berkeley School of Public Health, Berkeley, CA
| | | | | | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Steven P. Marso
- Midwest Heart and Vascular Institute, HCA Midwest Health, Overland Park, KS
| | | | - John Buse
- Division of Endocrinology and Metabolism, UNC School of Medicine, Chapel Hill, NC
| | | |
Collapse
|
39
|
Seino H, Onishi Y, Eguchi K, Nishijima K, Sato T, Shirabe S. Cardiovascular disease prevalence in adults with type 2 diabetes in Japan: results from the Japanese centers in the CAPTURE study. Diabetol Int 2023; 14:172-182. [PMID: 37090129 PMCID: PMC10113416 DOI: 10.1007/s13340-022-00612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/06/2022] [Indexed: 01/15/2023]
Abstract
Introduction CAPTURE was a cross-sectional, non-interventional study (NCT03786406, NCT03811288) investigating the prevalence and characteristics of cardiovascular disease (CVD) in adults with type 2 diabetes (T2D) across 13 countries worldwide. Here we present the findings for Japan. Materials and methods Data were collected from adults aged ≥ 20 years (aged ≥ 18 years in countries outside Japan) with T2D who were managed in clinics or hospitals in 2019. Standardized methodology was used for all countries. The prevalence of CVD and its subtypes was estimated, weighted by care setting (clinics versus hospitals). Results Among participants from Japan (total: 800; clinics: 440; hospitals: 360), mean (standard deviation) age was 65.6 (11.2) years and glycated hemoglobin 7.2% (0.9). Sixty-seven percent of participants were male, 57.8% had diabetes duration > 10 years, 49.8% had body mass index ≥ 25 kg/m2 and 63.1% had hypertension. The weighted prevalences (95% confidence interval [CI]) of CVD and atherosclerotic CVD were 37.3% (34.2;40.3) and 33.5% (30.6;36.4), respectively. The prevalence (95% CI) of the most common subtypes of CVD was: carotid artery disease 20.5% (18.2;22.8), coronary heart disease 11.9% (9.7;14.1) and cerebrovascular disease 10.4% (8.3;12.5). Conclusions These contemporary data from the CAPTURE study on CVD prevalence in adults with T2D in Japan show that approximately one in three adults with T2D had established CVD, which is comparable to the prevalence in the global study cohort. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-022-00612-y.
Collapse
Affiliation(s)
- Hiroaki Seino
- Seino Internal Medicine Clinic, 6-192-2 Kaisei, Koriyama, Fukushima 963-8851 Japan
| | - Yukiko Onishi
- The Institute of Medical Science, Asahi Life Foundation, Tokyo, Japan
| | | | | | | | | |
Collapse
|
40
|
Prediction of microvascular complications in diabetic patients without obstructive coronary stenosis based on peri-coronary adipose tissue attenuation model. Eur Radiol 2023; 33:2015-2026. [PMID: 36255489 DOI: 10.1007/s00330-022-09176-6] [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: 04/19/2022] [Revised: 07/29/2022] [Accepted: 09/18/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the predictive value of peri-coronary adipose tissue (PCAT) attenuation for microvascular complications in diabetic patients without significant stenosis and to develop a prediction model for early risk stratification. METHODS This study retrospectively included patients clinically identified for coronary computed tomography angiography (CCTA) and type 2 diabetes between January 2017 and December 2020. All patients were followed up for at least 1 year. The clinical data and CCTA-based imaging characteristics (including PCAT of major epicardial vessels, high-risk plaque features) were recorded. In the training cohort comprising of 579 patients, two models were developed: model 1 with the inclusion of clinical factors and model 2 incorporating clinical factors + RCAPCAT using multivariable logistic regression analysis. An internal validation cohort comprising 249 patients and an independent external validation cohort of 269 patients were used to validate the proposed models. RESULTS Microvascular complications occurred in 69.1% (758/1097) of the current cohort during follow-up. In the training cohort, model 2 exhibited improved predictive power over model 1 based on clinical factors (AUC = 0.820 versus 0.781, p = 0.003) with lower prediction error (Brier score = 0.146 versus 0.164) compared to model 1. Model 2 accurately categorized 78.58% of patients with diabetic microvascular complications. Similar performance of model 2 in the internal validation cohort and the external validation cohort was further confirmed. CONCLUSIONS The model incorporating clinical factors and RCAPCAT predicts the development of microvascular complications in diabetic patients without significant coronary stenosis. KEY POINTS • Hypertension, HbA1c, duration of diabetes, and RCAPCAT were independent risk factors for microvascular complications. • The prediction model integrating RCAPCAT exhibited improved predictive power over the model only based on clinical factors (AUC = 0.820 versus 0.781, p = 0.003) and showed lower prediction error (Brier score=0.146 versus 0.164).
Collapse
|
41
|
Clinical outcomes by atherosclerotic cardiovascular disease risk score and blood pressure level in high risk individuals with type 2 diabetes. J Hum Hypertens 2023; 37:181-188. [PMID: 35184142 DOI: 10.1038/s41371-022-00661-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/17/2022] [Accepted: 02/04/2022] [Indexed: 11/09/2022]
Abstract
Clinical practice guidelines for patients with diabetes recommend using blood pressure (BP) and atherosclerotic cardiovascular disease (ASCVD) risk to guide antihypertensive treatment. While this approach directs treatment to patients who should receive a large ASCVD risk reduction, its effect on other outcomes is uncertain. The aim of this study was to assess the contributions of systolic blood pressure level (SBP) and predicted 10-year ASCVD risk using Pooled Cohort risk equations to the prediction of major macrovascular disease, death and major microvascular disease in patients with diabetes. Data came from 7426 individuals with type 2 diabetes (T2D) without macrovascular disease at baseline in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. The risk for major macrovascular events and death increased progressively across ASCVD risk categories. Compared to participants with 10-year predicted ASCVD risk <20% and SBP <130 mmHg, the hazard ratios (HRs) (95% confidence intervals (CIs)) associated with SBP ≥150 mmHg and 10-year predicted ASCVD risk <20%, 20-34% and ≥35% were 1.01 (0.58, 1.77), 1.90 (1.28, 2.84) and 2.82 (1.98, 4.01) for major macrovascular disease, respectively, and 0.83 (0.42, 1.62), 1.79 (1.13, 2.82) and 3.29 (2.22, 4.88) for death, respectively. The risk for major microvascular disease increased with BP regardless of ASCVD risk; HRs for SBP ≥150 mmHg and 10-year predicted ASCVD risk <20%, 20-34% and ≥35% vs. ASCVD risk <20% and SBP <130 mmHg were 1.52 (1.08,2.13), 1.47 (1.10, 1.96) and 1.23 (0.94, 1.60), respectively. ASCVD risk in addition to SBP improved the estimation of major macrovascular events and death but not major microvascular events among individuals with T2D.
Collapse
|
42
|
Gao L, Cheng Z, Su B, Su X, Song W, Guo Y, Liao L, Chen X, Li J, Tan X, Xu F, Pang S, Wang K, Ye J, Wang Y, Chen L, Sun J, Ji L. Efficacy and safety of janagliflozin as add-on therapy to metformin in Chinese patients with type 2 diabetes inadequately controlled with metformin alone: A multicentre, randomized, double-blind, placebo-controlled, phase 3 trial. Diabetes Obes Metab 2023; 25:785-795. [PMID: 36433709 DOI: 10.1111/dom.14926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the efficacy and safety of janagliflozin in Chinese patients with type 2 diabetes (T2D) inadequately controlled with metformin monotherapy. MATERIALS AND METHODS This multicentre phase 3 trial included a 24-week, randomized, double-blind, placebo-controlled period, followed by a 28-week extension period. Patients (N = 421) with HbA1c of 7.0% or higher and 10.5% or less were randomized (1:1:1) to receive once-daily placebo, janagliflozin 25 or 50 mg. After the 24-week treatment period, patients on placebo were re-randomized (1:1) to janagliflozin 25 or 50 mg for the additional 28-week treatment, whereas patients on janagliflozin maintained the same therapy. The primary endpoint was the change from baseline in HbA1c to week 24. RESULTS At week 24, the placebo-adjusted least squares mean changes of HbA1c were -0.58% and -0.58% with janagliflozin 25 and 50 mg, respectively (P < .0001 for both). The proportion of patients achieving HbA1c less than 7.0% was higher with janagliflozin 25 and 50 mg compared with placebo (41.8%, 41.7% and 28.0%, respectively). Both janagliflozin doses provided significant reductions in fasting plasma glucose, 2-hour postprandial glucose, body weight and systolic blood pressure, and improvements in high-density lipoprotein cholesterol and insulin sensitivity compared with placebo (P < .05 for all). The trends in improvement of these variables were retained during the 28-week extension period. No severe hypoglycaemia occurred throughout the whole 52-week treatment. CONCLUSIONS Janagliflozin 25 or 50 mg once-daily added to metformin therapy significantly improved glycaemic control, reduced body weight and systolic blood pressure, improved high-density lipoprotein cholesterol and insulin sensitivity, and was generally well-tolerated by Chinese T2D patients who had poor glycaemic control with metformin monotherapy.
Collapse
Affiliation(s)
- Leili Gao
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Zhifeng Cheng
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Benli Su
- Department of Endocrinology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Xiuhai Su
- Department of Endocrinology, Cangzhou Hospital of Integrated TCM-WM Hebei, Cangzhou, China
| | - Weihong Song
- Department of Endocrinology, Chenzhou First People's Hospital, Chenzhou, China
| | - Yushan Guo
- Department of Endocrinology, The Affiliated Hospital of Beihua University, Jilin, China
| | - Lin Liao
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xiaowen Chen
- Department of Endocrinology, Huangshi Central Hospital, Huangshi, China
| | - Jiarui Li
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, China
| | - Xingrong Tan
- Department of Endocrinology, The Ninth People's Hospital of Chongqing, Chongqing, China
| | - Fangjiang Xu
- Department of Endocrinology, Linyi Central Hospital, Linyi, China
| | - Shuguang Pang
- Department of Endocrinology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Kun Wang
- Department of Endocrinology, Nanjing Jiangning Hospital, Nanjing, China
| | - Jun Ye
- Department of Endocrinology, The Second People's Hospital of Hefei, Hefei, China
| | - Yuan Wang
- Department of Endocrinology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lili Chen
- Department of Endocrinology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingfang Sun
- Jilin Huisheng Bio-pharmaceutical Co., Ltd, Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| |
Collapse
|
43
|
Connections between Diabetes Mellitus and Metabolic Syndrome and the Outcome of Cardiac Dysfunctions Diagnosed during the Recovery from COVID-19 in Patients without a Previous History of Cardiovascular Diseases. BIOLOGY 2023; 12:biology12030370. [PMID: 36979062 PMCID: PMC10044929 DOI: 10.3390/biology12030370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
(1) Background: Throughout the COVID-19 pandemic, it became obvious that individuals suffering with obesity, diabetes mellitus (T2DM), and metabolic syndrome (MS) frequently developed persisting cardiovascular complications, which were partially able to explain the onset of the long-COVID-19 syndrome. (2) Methods: Our aim was to document, by transthoracic echocardiography (TTE), the presence of cardiac alterations in 112 patients suffering from post-acute COVID-19 syndrome and T2DM, MS, and/or obesity, in comparison to 91 individuals without metabolic dysfunctions (MD); (3) Results: in patients with MD, TTE borderline/abnormal left (LVF) and/or right ventricular function (RVF), alongside diastolic dysfunction (DD), were more frequently evidenced, when compared to controls (p ˂ 0.001). Statistically significant associations between TTE parameters and the number of factors defining MS, the triglyceride-glucose (TyG) index, the severity of the SARS-CoV-2 infection, and the number of persisting symptoms (p ˂ 0.001) were noted. Significant predictive values for the initial C-reactive protein and TyG index levels, both for the initial and the 6-month follow-up levels of these TTE abnormalities (p ˂ 0.001), were highlighted by means of a multivariate regression analysis. (4) Conclusions: in diabetic patients with MS and/or obesity with comorbid post-acute COVID-19 syndrome, a comprehensive TTE delineates various cardiovascular alterations, when compared with controls. After 6 months, LVF and RVF appeared to normalize, however, the DD—although somewhat improved—did persist in approximately a quarter of patients with MD, possibly due to chronic myocardial changes.
Collapse
|
44
|
Chen J, Fan L, Maughn K, Rey GG, Liu Y, Nelson DR, Hood RC. Trajectory of glycated haemoglobin over time, using real-world data, in type 2 diabetes patients with obesity on a U-100 basal-bolus insulin regimen. Diabetes Obes Metab 2023; 25:1677-1687. [PMID: 36799018 DOI: 10.1111/dom.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
AIMS To identify patient clusters with poor glucose control among type 2 diabetes mellitus (T2DM) patients with obesity who are receiving basal-bolus insulin and to identify the potential therapeutic inertia factors associated with poor control. METHODS Glycated haemoglobin (HbA1c) trajectories across a 3-year period were structured at 6-month intervals for a retrospective cohort of T2DM patients with obesity on basal-bolus insulin from the Veterans' Health Administration database. Based on each patient's longitudinal HbA1c features, an unsupervised clustering procedure was used to determine the numbers of clusters and associated trajectory patterns. Multinomial logistic regression was used to examine the association between HbA1c trajectory clusters and patient characteristics/treatment patterns. RESULTS A total of 51 273 patients were included, of whom 11.2% were in a subgroup with persistent missingness of HbA1c values. For those with sufficient HbA1c observations, cluster analysis indicated six distinct HbA1c trajectories: stable low (35.8%); stable high (20.8%); descending low (10.5%); ascending low (10.2%); descending high (5.7%); and ascending high (5.7%). Being of Black ethnicity, not initiating noninsulin antihyperglycaemic agents (sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists or thiazolidinediones) or concentrated insulin, low adherence (measured by proportion of days covered), and reduced insulin prescription refills were factors associated with poorer HbA1c clusters; similar factors were associated with persistent HbA1c missingness. CONCLUSION The present study found the potential for therapeutic inertia among a significant proportion of T2DM patients with obesity on basal-bolus insulin. Subgrouping T2DM patients based on HbA1c missingness and HbA1c trajectories can inform disease management strategies.
Collapse
Affiliation(s)
- Jieling Chen
- Value, Evidence, and Outcomes | Real World Analytics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ludi Fan
- Value, Evidence, and Outcomes | Real World Analytics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Keisha Maughn
- Real World Evidence, STATinMED Research, Plano, Texas, USA
| | - Gabriel G Rey
- Real World Evidence, STATinMED Research, Plano, Texas, USA
| | - Yi Liu
- Real World Evidence, STATinMED Research, Plano, Texas, USA
| | - David R Nelson
- Value, Evidence, and Outcomes | Real World Analytics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Robert C Hood
- Endocrine Clinic of Southeast Texas, Beaumont, Texas, USA
| |
Collapse
|
45
|
Verma S, Sabbour H, Alamuddin N, Alawadi F, Alkandari H, Almahmeed W, Assaad-Khalil SH, Haddad J, Lombard L, Malik RA, Mashaki Ceyhan E, Prasad P, Tombak G, Salek S. A cross-sectional study of the prevalence and clinical management of atherosclerotic cardiovascular diseases in patients with type 2 diabetes across the Middle East and Africa (PACT-MEA): Study design and rationale. Diabetes Obes Metab 2023; 25:1444-1452. [PMID: 36775980 DOI: 10.1111/dom.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 02/14/2023]
Abstract
AIM To investigate the epidemiology and clinical management of patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (eASCVD) or high/very high ASCVD risk, defined by the 2021 European Society of Cardiology Guidelines, in seven countries in the Middle East and Africa (PACT-MEA; NCT05317845), and to assess physicians' attitudes and the basis for their decision-making in the management of these patients. MATERIALS AND METHODS PACT-MEA is a cross-sectional, observational study undertaken in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa and the United Arab Emirates based on a medical chart review of approximately 3700 patients with T2D in primary and secondary care settings, and a survey of approximately 400 physicians treating patients with T2D. RESULTS The primary and secondary objectives are to determine the prevalence of eASCVD and high/very high ASCVD risk in patients with T2D. Current treatment with cardioprotective antidiabetic medication, the proportion of patients meeting the treatment criteria for reimbursement in the study countries where there is an applicable reimbursement guideline, and physician-reported factors in clinical decision-making in T2D management, will also be assessed. CONCLUSIONS This large cross-sectional study will establish the estimated prevalence and management of eASCVD and high/very high ASCVD risk in patients with type 2 diabetes across the Middle East and Africa.
Collapse
Affiliation(s)
- Subodh Verma
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hani Sabbour
- Heart, Vascular & Thoracic Institute at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Naji Alamuddin
- Royal College of Surgeons in Ireland-Bahrain, King Hamad University Hospital, Adliya, Bahrain
| | - Fatheya Alawadi
- Department of Endocrinology, Dubai Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Hessa Alkandari
- Department of Pediatrics, Farwaniya Hospital, Kuwait City, Kuwait
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Wael Almahmeed
- Heart, Vascular & Thoracic Institute at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Samir H Assaad-Khalil
- Unit of Diabetes, Lipidology and Metabolism, Alexandria University, Alexandria, Egypt
- Department of Internal Medicine/Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jihad Haddad
- Endocrinology Section, Bader Medical Complex, Amman, Jordan
| | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | | | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Institute for Medicines Development, Cardiff, UK
| |
Collapse
|
46
|
Moita CF, Marau G, Corte-Real S, Dantas A. Adherence to European guidelines for the use of aspirin in primary health care. Rev Port Cardiol 2023:S0870-2551(23)00100-2. [PMID: 36758746 DOI: 10.1016/j.repc.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/04/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular disease remains a leading cause of global morbidity and mortality. The administration of low doses of aspirin in secondary prevention of atherosclerotic cardiovascular disease (ASCVD) has been clearly established. However, the most recent guidelines do not recommend aspirin in primary prevention, reserving it for high-risk patients and after a risk/benefit assessment. The aim of this study was to assess adherence to European guidelines for the use of aspirin in primary and secondary prevention of ASCVD in primary health care. METHODS The study population consisted of individuals aged >50 years registered at two primary health care units without (primary prevention) and with (secondary prevention) previous ASCVD events. RESULTS We studied a total of 1262 individuals, 720 in primary prevention and 542 in secondary prevention. A total of 61 individuals (8.5%) were under aspirin therapy in primary prevention, most of them taking 150 mg/day (57%). In secondary prevention, 195 patients (27%) were receiving aspirin only, most taking 150 mg/day (52%), and 166 patients (31%) were not under any antithrombotic or anticoagulant therapy. The 100 mg dosage was predominant in patients with ischemic heart disease with (64%) and without (64%) angina, as well as those with myocardial infarction (61.5%) and peripheral vascular disease (62%). CONCLUSIONS In this study, the prevalence of aspirin use in primary prevention was 8.5%. We found that 30% of patients were not taking either antithrombotic or anticoagulation therapy in secondary prevention. In both primary and secondary prevention, the 150 mg dosage was predominant.
Collapse
Affiliation(s)
| | - Gonçalo Marau
- USF S. Julião, ACES Lisboa Ocidental e Oeiras, Oeiras, Portugal
| | | | - Ana Dantas
- USF S. Martinho de Alcabideche, ACES Cascais, Cascais, Portugal
| |
Collapse
|
47
|
Pai SL, Haehn DA, Pitruzzello NE, Rao SN, Meek SE, Irizarry Alvarado JM. Reducing Infection Rates with Enhanced Preoperative Diabetes Mellitus Diagnosis and Optimization Processes. South Med J 2023; 116:215-219. [PMID: 36724538 DOI: 10.14423/smj.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Hyperglycemia and increased preoperative hemoglobin A1c (HbA1c) are associated with perioperative morbidity and death. For nonurgent operations, adequate glycemic control before surgery is recommended. Our surgical practice needed a process for preoperative diabetes mellitus (DM) diagnosis and glycemic optimization. METHODS Our review of the existing preoperative evaluation process found that patients without a DM diagnosis but with random plasma glucose ≥200 mg/dL received no additional screening. Patients with DM routinely receive neither preoperative HbA1c screening nor DM management when HbA1c is ≥8.0%. RESULTS A new preoperative evaluation process was designed. HbA1c screening was automatically performed for patients with random plasma glucose ≥200 mg/dL. For patients with a DM diagnosis, an HbA1c test was performed. Specialty consultation was prompted for patients with known DM and HbA1c ≥8.0% and those with no DM diagnosis but HbA1c ≥6.5%. In the first year postimplementation, 9320 patients received a basic metabolic panel; 263 had random plasma glucose ≥200 mg/dL that triggered an HbA1c check. In total, 123 patients (99 with and 24 without a DM diagnosis) were referred to endocrinology; 13 received a new DM diagnosis. Twenty patients had surgery delayed for DM treatment. All of the patients received individualized medication instructions for the perioperative period. Among patients with random plasma glucose ≥200 mg/dL, incidence rates for surgical site infection pre- and postimplementation were 47.8/1000 and 3.8/1000 population. CONCLUSIONS The implemented process benefited patients scheduled for nonurgent procedures by optimizing glucose control and lowering infection rates through earlier preoperative DM diagnosis, glycemic management, and standardized patient medication instruction.
Collapse
Affiliation(s)
- Sher-Lu Pai
- From the Department of Anesthesiology and Perioperative Medicine
| | - Daniela A Haehn
- the Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | | | | | | | | |
Collapse
|
48
|
Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes. Clin Res Cardiol 2023; 112:215-226. [PMID: 35396632 DOI: 10.1007/s00392-022-02016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023]
Abstract
IMPORTANCE Updated guidelines on diabetes recommend targeting sodium-glucose cotransporter-2 inhibitors (SGLT2i) at patients at risk of heart failure (HF) and glucagon-like peptide-1 receptor agonists (GLP1-RA) at those at greater risk of atherothrombotic events. OBJECTIVE We estimated the risk of different cardiovascular events in patients with type 2 diabetes (T2D) and newly established cardiovascular disease. DESIGN, SETTING AND PARTICIPANTS Patients with T2D and newly established cardiovascular disease from 1998 to 2016 were identified using Danish healthcare registers and divided into one of four phenotype groups: (1) HF, (2) ischemic heart disease (IHD), (3) transient ischemic stroke (TIA)/ischemic stroke, and (4) peripheral artery disease (PAD). The absolute 5-year risk of the first HF- or atherothrombotic event occurring after inclusion was calculated, along with the risk of death. MAIN OUTCOMES AND MEASURES The main outcome was the first event of either HF or an atherothrombotic event (IHD, TIA/ischemic stroke or PAD) in patients with T2D and new-onset cardiovascular disease. RESULTS Of the 37,850 patients included, 40% were female and the median age was 70 years. Patients with HF were at higher 5-year risk of a subsequent HF event (17.9%; 95% confidence interval (CI) 17.1-18.8%) than an atherothrombotic event (15.8%; 15.0-16.6%). Patients with IHD were at higher risk of a subsequent atherothrombotic event (24.6%; 23.9-25.3%) than developing HF, although the risk of HF was still substantial (10.6%; 10.2-11.1%). Conversely, patients with PAD were at low risk of developing HF (4.4%; 3.8-5.1%) but at high risk of developing an atherothrombotic event (15.9%; 14.9-17.1%). Patients with TIA/ischemic stroke had the lowest risk of HF (3.2%; 2.9-3.6%) and the highest risk of an atherothrombotic event (20.6%; 19.8-21.4). CONCLUSIONS In T2D, a patient's cardiovascular phenotype can help predict the pattern of future cardiovascular events.
Collapse
|
49
|
Djuricic I, Calder PC. Pros and Cons of Long-Chain Omega-3 Polyunsaturated Fatty Acids in Cardiovascular Health. Annu Rev Pharmacol Toxicol 2023; 63:383-406. [PMID: 36662586 DOI: 10.1146/annurev-pharmtox-051921-090208] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The long-chain omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are found in seafood, supplements, and concentrated pharmaceutical preparations. Prospective cohort studies demonstrate an association between higher intakes of EPA+DHA or higher levels of EPA and DHA in the body and lower risk of developing cardiovascular disease (CVD), especially coronary heart disease and myocardial infarction, and of cardiovascular mortality in the general population. The cardioprotective effect of EPA and DHA is due to the beneficial modulation of a number of risk factors for CVD. Some large trials support the use of EPA+DHA (or EPA alone) in high-risk patients, although the evidence is inconsistent. This review presents key studies of EPA and DHA in the primary and secondary prevention of CVD, briefly describes potential mechanisms of action, and discusses recently published RCTs and meta-analyses. Potential adverse aspects of long-chain omega-3 fatty acids in relation to CVD are discussed.
Collapse
Affiliation(s)
- Ivana Djuricic
- Department of Bromatology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Philip C Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom;
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| |
Collapse
|
50
|
Harms PP, Elders PPJM, Femke R, Lissenberg-Witte BI, Tan HL, Beulens JWJ, Nijpels G, van der Heijden AA. Longitudinal association of ECG abnormalities with major adverse cardiac events in people with type 2 diabetes: The Hoorn Diabetes Care System cohort. Eur J Prev Cardiol 2023:6982519. [PMID: 36625405 DOI: 10.1093/eurjpc/zwac314] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/15/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
AIMS To investigate the association of (changes in) ECG abnormalities with incident major adverse cardiac events (MACE) in people with type 2 diabetes (T2D) without pre-existing cardiovascular disease (CVD). METHODS A prospective longitudinal study of 11,993 people with T2D without known CVD from the Hoorn Diabetes Care System cohort. Annually repeated measurements (1998-2018), included cardiovascular risk factors, over 70,000 ECGs, and self-reported cardiovascular events. ECG abnormalities were classified according to the Minnesota Classification as prolonged PR duration, prolonged QRS duration, left QRS-axis, QS pattern, ST-segment/T-wave abnormalities, or tall R-wave. The association of ECG abnormalities with MACEs was assessed using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors and medication use (Hazzard Ratios with 95%CIs). RESULTS During a median follow-up of 6.6 (IQR, 3.1-10.7) years, 5445 (45.4%) of the participants had an ECG abnormality (prevalent or incident) at any of the median 6 (IQR, 3-10) annual ECG recordings, and 905 people (7.5%) had a MACE (529 CHD, 250 HF, 126 SCA). After adjustment, most ECG abnormalities were associated with HF: prolonged QRS duration (HR, 4.01 (95%CI, 2.67-6.03)), QS pattern (2.68 (0.85-8.49)), ST-segment/T-wave abnormalities (4.26 (2.67-6.80)), and tall R-wave (2.23 (1.33-3.76)). Only QS pattern (2.69 (1.20-6.03)), and ST-segment/T-wave abnormalities (2.11 (1.48-3.02)) were associated with CHD. These associations were robust across age, sex, hypertension, or estimated CVD risk subgroups. CONCLUSION In people with T2D without pre-existing cardiovascular disease, ECG abnormalities related to decelerated conduction, ischemia and hypertrophy are predominantly early signs of emerging HF, while only abnormalities related to ischemic disorders are signs of CHD.
Collapse
Affiliation(s)
- Peter P Harms
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Petra P J M Elders
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Rutters Femke
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Boelelaan 1117, Amsterdam, The Netherlands
| | - Hanno L Tan
- Amsterdam UMC location University of Amsterdam, Clinical and Experimental Cardiology, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences research institute, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Joline W J Beulens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Giel Nijpels
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Amber A van der Heijden
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | | |
Collapse
|