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Álvarez Marcos F, Llaneza Coto JM, Camblor Santervás LA, Zanabili Al-Sibbai AA, Alonso Pérez M. Five Year Post-Endovascular Aneurysm Repair Aneurysm Sac Evolution in the GREAT Registry: an Insight in Diabetics Using Propensity Matched Controls. Eur J Vasc Endovasc Surg 2024; 67:912-922. [PMID: 37898359 DOI: 10.1016/j.ejvs.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 09/17/2023] [Accepted: 10/24/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To assess differences in the five year abdominal aortic aneurysm (AAA) sac regression rate after endovascular aneurysm repair (EVAR) in patients with and without diabetes mellitus (DM). METHODS An international prospective registry (Europe, USA, Brazil, Australia, and New Zealand) of patients treated with the GORE EXCLUDER endograft. All scheduled EVARs for infrarenal AAA between 2014 and 2016 with complete five year imaging follow up were included. Emergency procedures, ancillary proximal procedures, and inflammatory and infectious aetiologies were excluded. Descriptive and inferential statistics, and Cox proportional hazards survival models were used. A control group of patients without DM with similar age and comorbidities was selected using propensity scores, matched in a 1:2 scheme. RESULTS A total of 2 888 patients (86.1% male; mean age 73.5 ± 8 years) was included, of whom 545 (18.9%) had DM. Patients with DM had higher rates of hypertension (89.2% vs. 78.4%), dyslipidaemia (76.0% vs. 60.7%), coronary artery disease (52.3% vs. 37.9%), and chronic renal impairment (20.9% vs. 14.0%) (all p < .001). The mean pre-procedural AAA diameter was 58.1 ± 10 mm. Five years post-EVAR, the type 1A endoleak rate was 1.1% (0.6% DM vs. 1.2% non-DM), the endograft related re-intervention rate was 7.3% (6.2% vs. 7.6%), the major adverse cardiovascular event (MACE) rate was 1.4% (1.1% vs. 1.5%), and aortic related mortality rate was 1.0% (0.6% vs. 1.2%), without statistically significant differences between groups. The overall five year mortality rate was higher in diabetics (36.3% vs. 30.5%; hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.07 - 1.58; p = .001). No statistically significant differences were found in sac regression rate (≥ 5 mm) between diabetics and non-diabetics 70.0% vs. 73.1%; HR 0.88, 95% CI 0.75-1.04; p = .131. These differences remained statistically non-significant after excluding patients performed out of instructions for use (p = .61) and patients with types 1, 2 or 3 endoleaks (p = .39). CONCLUSION The paradoxical relationship between DM and AAA does not appear to result in differences in post-EVAR sac regression rates. However, even when controlling for other comorbidities, patients with DM undergoing EVAR may have a higher five year mortality rate.
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Affiliation(s)
- Francisco Álvarez Marcos
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
| | - José M Llaneza Coto
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Lino A Camblor Santervás
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Ahmad A Zanabili Al-Sibbai
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Manuel Alonso Pérez
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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Zhao X, Cheng Z, Zhang H, Guo Y, Zhao L, Zhang C, Ye P, Zhang K, Ma X, Wu Q. Glucagon-Like Peptide-1 Inhibits the Progression of Abdominal Aortic Aneurysm in Mice: The Earlier, the Better. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07456-x. [PMID: 37145254 DOI: 10.1007/s10557-023-07456-x] [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: 04/19/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Glucagon-like peptide-1 (GLP-1) has a cardiovascular protective effect by preventing abdominal aortic aneurysm (AAA) formation. However, it is unclear at what point the agent should be administered to achieve the optimal effect. In this study, we aimed to determine whether administering the GLP-1 receptor agonist liraglutide during the earlier stages would more efficiently inhibit AAA progression in mice. METHODS Depending on the group, mice were given a daily dose of 300 μg/kg liraglutide for 28 days at 7, 14, and 28 days after aneurysm induction. The morphology of the abdominal aorta was monitored using 7.0 T magnetic resonance imaging (MRI) during the administration of liraglutide. After 28 days of administration, the AAA dilatation ratio was calculated, and histopathological examination was performed. Oxidative stress levels were evaluated by the expression of malondialdehyde (MDA) and matrix metalloproteinases (MMPs). The inflammatory response was also evaluated. RESULTS Liraglutide treatment led to a decrease in AAA formation, including a reduction in abdominal aorta expansion, elastin degradation in the elastic laminae, and vascular inflammation caused by leukocyte infiltration. The expression of MDA and the activity of MMPs (MMP-2, MMP-9) also decreased. Notably, administering liraglutide during the early stages resulted in a significant reduction in the dilatation rate of the aortic wall, as well as in MDA expression, leukocyte infiltration, and MMP activity in the vascular wall. CONCLUSIONS The GLP-1 receptor agonist liraglutide was found to inhibit AAA progression in mice by exerting anti-inflammatory and antioxidant effects, particularly during the early stages of AAA formation. Therefore, liraglutide may represent a potential pharmacological target for the treatment of AAA.
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Affiliation(s)
- Xinghan Zhao
- Department of Interventional therapy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China
| | - Zhang Cheng
- Department of Interventional therapy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China
| | - Hongbo Zhang
- Department of Interventional therapy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China
| | - Yingkun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Sichuan University, West China Second University Hospital, Sichuan, 610041, Chengdu, People's Republic of China
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China
| | - Chen Zhang
- Department of Interventional therapy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China
| | - Pengfei Ye
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kun Zhang
- Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Sichuan University, West China Second University Hospital, Sichuan, 610041, Chengdu, People's Republic of China
| | - Xiaohai Ma
- Department of Interventional therapy, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, China.
| | - Qihong Wu
- Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Sichuan University, West China Second University Hospital, Sichuan, 610041, Chengdu, People's Republic of China.
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Abstract
ABSTRACT The incidence of abdominal aortic aneurysm (AAA) in the elderly is increasing year by year with high mortality. Current treatment is mainly through surgery or endovascular intervention, which is not sufficient to reduce future risk. Therefore, we still need to find an effective conservative measure as an adjunct therapy or early intervention to prevent AAA progression. Traditional therapeutic agents, such as β-receptor blockers, calcium channel blockers, and statins, have been shown to have limited effects on the growth of AAA. Recently, sodium-glucose cotransport proteins inhibitors (SGLT2is), a new class hypoglycemic drug, have shown outstanding beneficiary effects on cardiovascular diseases by plasma volume reduction, vascular tone regulation, and various unidentified mechanisms. It has been demonstrated that SGLT2i is abundantly expressed in the aorta, and some studies also showed promising results of SGLT2i in treating animal AAA models. This article aims to summarize the recent progress of AAA studies and look forward to the application of SGLT2i in AAA treatment for early intervention or adjunct therapy after surgical repair or stent graft.
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Affiliation(s)
- Zhongtiao Jin
- Master of Medicine, Department of Endocrinology, Renmin Hospital of Wuhan University, 430060, China; and
| | - Hongping Deng
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, 430060, China.
| | - Sizheng Xiong
- Department of Vascular Surgery, Renmin Hospital of Wuhan University, 430060, China.
| | - Ling Gao
- Master of Medicine, Department of Endocrinology, Renmin Hospital of Wuhan University, 430060, China; and
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Tian T, Sun W, Du J, Sun Y. Analysis of co-expression gene network associated with intracranial aneurysm and type 2 diabetes mellitus. Front Neurol 2022; 13:1032038. [PMID: 36561297 PMCID: PMC9763588 DOI: 10.3389/fneur.2022.1032038] [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: 08/30/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
To screen for common target genes in intracranial aneurysms (IA) and type 2 diabetes mellitus (T2DM), construct a common transcriptional regulatory network to predict clusters of candidate genes involved in the pathogenesis of T2DM and IA, and identify the common neurovascular markers and pathways in T2DM causing IA. Microarray datasets (GSE55650, GSE25462, GSE26969, GSE75436, and GSE13353) from the GEO database were analyzed in this research. Screening of the IA and the T2DM datasets yielded a total of 126 DEGs, among which 78 were upregulated and 138 were downregulated. Functional enrichment analysis revealed that these DEGs were enriched for a total of 68 GO pathways, including extracellular matrix composition, coagulation regulation, hemostasis regulation, and collagen fiber composition pathways. We also constructed transcriptional regulatory networks, and identified key transcription factors involved in both the conditions. Univariate logistic regression analysis showed that ARNTL2 and STAT1 were significantly associated with the development of T2DM and IA, acting as the common neurovascular markers for both the diseases. In cellular experiments, hyperglycemic microenvironments exhibited upregulated STAT1 expression. STAT1 may be involved in the pathogenesis of IA in T2DM patients. Being the common neurovascular markers, STAT1 may acts as novel therapeutic targets for the treatment of IA and T2DM.
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Affiliation(s)
- Tian Tian
- Department of Neurological Surgery, Chengde Medical University Affiliated Hospital, Chengde, China
| | - Wenhao Sun
- Department of Neurological Surgery, Chengde Medical University Affiliated Hospital, Chengde, China
| | - Jia Du
- Department of Neurological Surgery, Cangzhou Center Hospital, Cangzhou, China
| | - Yafei Sun
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China,*Correspondence: Yafei Sun
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Dapagliflozin Ameliorates the Formation and Progression of Experimental Abdominal Aortic Aneurysms by Reducing Aortic Inflammation in Mice. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:8502059. [PMID: 35126822 PMCID: PMC8816542 DOI: 10.1155/2022/8502059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 02/08/2023]
Abstract
Background. Dapagliflozin, a sodium glucose transporter protein-2 (SGLT-2) inhibitor, reduces the risk for cardiovascular diseases. However, the influence of dapagliflozin on nondissecting abdominal aortic aneurysms (AAAs) remains unclear. Methods. AAAs were created in male C57BL/6 mice via intra-aortic porcine pancreatic elastase (PPE) infusion. Mice were daily treated with dapagliflozin (1 or 5 mg/kg body weight) or an equal volume of vehicle through oral gavage beginning one day prior to PPE infusion for 14 days. To investigate its translational value, dapagliflozin or vehicle was also administered to mice with existing AAAs in another cohort. Aortic diameters were measured prior to (day 0 for baseline) and 14 days after PPE infusion. After sacrifice, mice aortae were collected, and following histological analyses were performed. Results. Dapagliflozin treatment significantly reduced aneurysmal aortic expansion following PPE infusion as compared to vehicle treatment especially at 5 mg/kg body weight (approximately 21% and 33% decreases in 1 and 5 mg/kg treatment groups, respectively). The dose-dependent attenuation of AAAs by dapagliflozin was also confirmed on histological analyses. Dapagliflozin remarkably reduced aortic accumulation of macrophages, CD4+ T cells, and B cells particularly following dapagliflozin treatment at 5 mg/kg. Dapagliflozin treatment also markedly attenuated medial SMC loss. Though the difference was not significant, dapagliflozin treatment tended to attenuate CD8+ T cells and elastin degradation. Dapagliflozin treatment at 5 mg/kg caused a 53% reduction in neovessel density. Furthermore, dapagliflozin treatment mitigated further progress of existing AAAs. Conclusion. Dapagliflozin treatment ameliorated PPE-induced AAAs by inhibiting aortic leukocytes infiltration and angiogenesis.
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